SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person*
| 103 NORTHPARK BOULEVARD |
| SUITE 300 |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/25/2004
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3. Issuer Name and Ticker or Trading Symbol
HORNBECK OFFSHORE SERVICES INC /LA
[ HOS ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
| Shareholder of 10% owner |
|
5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
4. Nature of Indirect Beneficial Ownership (Instr.
5)
|
| Common Stock |
102,671 |
D |
|
| Common Stock |
2,051,746
|
I |
by affiliation |
| Common Stock |
27,176
|
I |
by family trusts |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
|
4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
|
6. Nature of Indirect Beneficial Ownership (Instr.
5)
|
| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Options (right to buy) |
03/09/2001
|
03/09/2011 |
Common Stock |
120,000 |
2.65 |
D |
|
| Explanation of Responses: |
|
|
|
| Remarks: |
|
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/s/ Timothy P. McCarthy poa for Christian G. Vaccari |
03/25/2004 |
|
** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
rrd29215_33293.html
SPECIAL POWER OF ATTORNEY UNITED STATES OF AMERICA
STATE OF LOUISIANA
PARISH/COUNTY OF ORLEANS
BE IT KNOWN that on 25th day of March, 2004, before me, CHRISTOPHER
MICHAEL WAPPEL, a Notary Public duly commissioned and qualified in and for aforesaid
parish/county and state, and in the presence of the undersigned witnesses, personally came and
appeared CHRISTIAN G. VACCARI, whose present mailing address is 1100 Poydras Suite
2000 New Orleans, Louisiana 70163; who does hereby appoint, reserving full power of
substitution and revocation: Todd M. Hornbeck, James O. Harp, Jr., Timothy P. McCarthy and
Paul M. Ordogne, each a resident of Louisiana, to act jointly or severally at their discretion, one
with full authority to act for the others, as his true and lawful attorney-in-fact, upon the following
terms and conditions:
1. Special Powers. The attorney-in-fact may act in the name, place and stead of the
undersigned, and on behalf of the undersigned do and execute all or any of the following acts,
deeds, and things, to-wit:
(a) Execute for and on behalf of the undersigned, in the undersigned's
capacity as an executive officer, director and/or 10% or more beneficial owner of shares of
common stock of Hornbeck Offshore Services, Inc. (the "Company"), Forms 3, 4, and 5, as
applicable, in accordance with Section 16 of the Securities Exchange Act of 1934, as amended
(the "Exchange Act"), and the rules thereunder.
(b) Do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete
and execute any amendment or amendments thereto, and file such form and any amendments
with the United States Securities and Exchange Commission and any stock exchange, association
or similar authority.
(c) Take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest
of, or legally required by, the undersigned, it being understood that the documents executed by
such attorney-in-fact on behalf of the undersigned pursuant to this Special Power of Attorney
shall be in such form and shall contain such terms and conditions as such attorney-in-fact may
approve in such attorney-in-fact's discretion.
(d) The undersigned hereby grants to such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite, necessary, or
proper to be done in the exercise of any of the rights and powers herein granted, as fully to all
intents and purposes as the undersigned might or could do if personally present, hereby ratifying
and confirming all that such attorney-in-fact shall lawfully do or cause to be done by virtue of
this power of attorney and the rights and powers herein granted. The undersigned acknowledges
that the foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned,
is not assuming, nor is the Company assuming, any of the undersigned's responsibilities to
comply with Section 16 of the Exchange Act, or any other provision of the federal or state
securities laws, rules and regulations.
2. Effective Period. This Special Power of Attorney, and the powers expressed
herein, shall be effective from March 25, 2004, and shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's
holdings of and transactions in securities issued by the Company, unless earlier revoked by the
undersigned in accordance with the provisions contained herein.
3. Construction. This instrument is a special power of attorney, granting to the
attorney-in-fact only the specific powers expressed herein.
4. Revocation. This Special Power of Attorney may be voluntarily revoked by the
undersigned only by a written revocation delivered to the Company at its principal place of
business. The undersigned agrees that any third party who receives a copy of this power of
attorney may act under it. Revocation of this power of attorney is not effective as to a third party
until the third party receives actual notice of the revocation. The undersigned agrees to
indemnify the third party for any claims that arise against the third party because of reliance on
this power of attorney.
5. Disability of Principal. This Special Power of Attorney shall not terminate upon
the undersigned's disability or incompetency.
6. Bond. The attorney-in-fact shall not be obligated to furnish bond or other
security.
7. Reliance. This Special Power of Attorney shall be conclusive proof that the
rights, power, and authority granted to the attorney-in-fact are in full force and effect and may be
relied upon by any person who acts in good faith under this power of attorney. The undersigned's
death shall not revoke or terminate this agency as to the attorney-in-fact or any other person who
without actual knowledge of the undersigned's death acts in good faith under this power of
attorney. An affidavit executed by the attorney-in-fact, stating that he did not have at the time of
doing an act pursuant to this power of attorney actual knowledge of the revocation or termination
of this power of attorney, is in the absence of fraud, conclusive proof of the validity of the
attorney-in-fact's act.
8. Incapacity of Attorney-in-Fact. In the event any attorney-in-fact serving becomes
unable to discharge his fiduciary duties hereunder by reason of accident, physical or mental
deterioration, or other similar cause as certified by two independent, licensed physicians, each
affirming that he has examined the attorney-in-fact and that he has concluded based on his
examination that the attorney-in-fact is unable to discharge his duties hereunder, that attorney-in-
fact shall thereupon cease to be the attorney-in-fact as if he had resigned on the date of that
certification.
9. Governing Law. This power of attorney shall be governed by the laws of the
State of Louisiana in all respects. Should any provision hereof be held invalid, that invalidity
shall not affect the other provisions which shall remain in full force and effect.
10. Copies. This instrument may be filed of record in any jurisdiction as may be
deemed appropriate by the attorney-in-fact, and copies of this instrument certified as "true"
copies by the Clerk of any county or parish in which this instrument is filed shall be treated as
original copies for all purposes.
11. Captions. The captions used in this instrument have been inserted for
administrative convenience only and do not constitute matters to be construed in interpreting this
power of attorney.
THUS SIGNED ON the date indicated above at New Orleans, Orleans Parish, Louisiana
in the presence of the undersigned Notary Public, qualified in said State and Parish, and the
undersigned competent witnesses, who have signed with the parties after due reading of the
whole.
WITNESSES:
_/s/ _____
Print Name: /s/ Christian G. Vaccari
Title:
_/s/ _______________
NOTARY PUBLIC
/s/ Christopher Michael Wappel
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