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