0001493152-21-027720.txt : 20211109
0001493152-21-027720.hdr.sgml : 20211109
20211109213340
ACCESSION NUMBER: 0001493152-21-027720
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211105
FILED AS OF DATE: 20211109
DATE AS OF CHANGE: 20211109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LEVINE JACK
CENTRAL INDEX KEY: 0001124852
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40809
FILM NUMBER: 211394150
MAIL ADDRESS:
STREET 1: C/O BLINK CHARGING CO.
STREET 2: 407 LINCOLN ROAD, SUITE 704
CITY: MIAMI BEACH
STATE: FL
ZIP: 33139
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EzFill Holdings Inc
CENTRAL INDEX KEY: 0001817004
STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-AUTO DEALERS & GASOLINE STATIONS [5500]
IRS NUMBER: 834260623
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2125 BISCAYNE BLVD
STREET 2: #309
CITY: MIAMI
STATE: FL
ZIP: 33137
BUSINESS PHONE: 305-791-1169
MAIL ADDRESS:
STREET 1: 2125 BISCAYNE BLVD
STREET 2: #309
CITY: MIAMI
STATE: FL
ZIP: 33137
4
1
ownership.xml
X0306
4
2021-11-05
0
0001817004
EzFill Holdings Inc
EZFL
0001124852
LEVINE JACK
C/O EZFILL HOLDINGS, INC.
2125 BISCAYNE BLVD, #309
MIAMI
FL
33137
1
0
0
0
Common Stock
2021-11-05
4
A
0
20477
2.939
A
33763
D
Common Stock
186010
I
Cameo Life Sciences Investments LLC
On 11/05/2021, Mr. Levine was awarded $60,000 worth of restricted common stock pursuant to the EzFill 2020 Incentive Compensation Plan, with the common stock valued at the closing price on November 4, 2021 ($2.93 per share). These restricted shares of common stock will vest at the Company's next annual shareholders' meeting only if Mr. Levine remains a member of the Company's board of directors until such meeting.
Jack Levine is the Manager of Cameo Life Sciences Investments LLC and beneficially owns 186,010 shares of common stock, which are held by Cameo Life Sciences Investments, LLC.
/s/ Jack Levine
2021-11-09