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
 
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1. Name and Address of Reporting Person*
BOCK LOUIS C

(Last) (First) (Middle)
C/O BANKAMERICA VENTURES
950 TOWER LANE STE 700

(Street)
FOSTER CITY CA 94404

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/11/2004
3. Issuer Name and Ticker or Trading Symbol
DYNAVAX TECHNOLOGIES CORP [ DVAX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 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 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
Series B Convertible Preferred Stock 02/11/2004 (1) Common Stock 109,289 0(3) I See notes.(2)
Series C Convertible Preferred Stock 02/11/2004 (1) Common Stock 11,816 0(4) I See notes.(2)
Series D Convertible Preferred Stock 02/11/2004 (1) Common Stock 72,815 0(3) I See notes.(2)
Explanation of Responses:
1. 1) These securities are shares of preferred stock of Dynavax Technologies Corporation and do not have an expiration date. These securities will automatically convert into shares of Dynavax’s Common Stock upon the effectiveness of Dynavax’s initial public offering.
2. (2) Represents securities held by BA Venture Partners IV, of which the Reporting Person is a partner. The Reporting Person disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein.
3. (3) Convertible into common stock on a 1:1 ratio.
4. (4) Convertible into common stock on a 1:1.26 ratio.
Louis C. Bock 02/11/2004
** 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).
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