0001493152-22-016086.txt : 20220607
0001493152-22-016086.hdr.sgml : 20220607
20220607161604
ACCESSION NUMBER: 0001493152-22-016086
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220603
FILED AS OF DATE: 20220607
DATE AS OF CHANGE: 20220607
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: 221001398
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
2022-06-03
0
0001817004
EzFill Holdings Inc
EZFL
0001124852
LEVINE JACK
C/O EZFILL HOLDINGS INC.
2999 NE 191ST STREET
AVENTURA
FL
33180
1
0
0
0
Common Stock
2022-06-03
4
A
0
127687
0
A
427500
D
The shares will fully vest in 12 months from the grant date or one day before the Issuer's 2023 annual meeting, whichever is sooner. Should the Reporting Person leave the Issuer's board of directors prior to vesting, the Reporting Person will be awarded a grant on a pro rata basis based on the time spent as a member of the board of directors.
The Reporting Person holds 186,010 shares of Common Stock through an entity Cameo Life Sciences Investments, LLC.
Granted pursuant to the Issuer's equity incentive plan.
/s/ Jack Levine
2022-06-07