Sec Form 4 Filing - KOLARIK TYLER @ Mosaic Acquisition Corp. - 2017-12-04

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
KOLARIK TYLER
2. Issuer Name and Ticker or Trading Symbol
Mosaic Acquisition Corp. [ MOSC]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O MOSAIC ACQUISITION CORP., 375 PARK AVENUE
3. Date of Earliest Transaction (MM/DD/YY)
12/04/2017
(Street)
NEW YORK, NY10052
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Class A Ordinary Share 12/04/2017 P 5,000 A 5,000 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrants $ 11.5 12/04/2017 P 1,666.66 ( 2 ) ( 2 ) Class A Ordinary Share 1,666.66 ( 1 ) 1,666.6 6 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
KOLARIK TYLER
C/O MOSAIC ACQUISITION CORP.
375 PARK AVENUE
NEW YORK, NY10052
X
Signatures
/s/ Tyler S. Kolarik 12/06/2017
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On December 4, 2017, Mr. Kolarik acquired, at a price of $10.12 per unit, 5,000 units, with each unit consisting of (i) one Class A ordinary share, par value $0.0001 per share (the "Class A Shares"), of Mosaic Acquisition Corp. (the "Company") and (ii) one-third of one warrant (the "Warrants").
( 2 )Each whole Warrant is initially exercisable for one Class A Share at an exercise price of $11.50 per Class A Share, subject to certain adjustments. The Warrants may be exercised only during the period (i) commencing on the later of (a) date that is 30 days after the first date on which the Company completes a business combination and (b) October 23, 2018 and (ii) expiring five years after the completion of the Company's business combination or earlier upon redemption or liquidation.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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