0001493152-22-016085.txt : 20220607 0001493152-22-016085.hdr.sgml : 20220607 20220607161537 ACCESSION NUMBER: 0001493152-22-016085 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: Weiss Allen R CENTRAL INDEX KEY: 0001534426 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40809 FILM NUMBER: 221001389 MAIL ADDRESS: STREET 1: C/O DICK'S SPORTING GOODS, INC. STREET 2: 345 COURT STREET CITY: CORAOPOLIS STATE: PA ZIP: 15108 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 0001534426 Weiss Allen R C/O EZFILL HOLDINGS, INC. 2999 NE 191ST STREET AVENTURA FL 33180 1 0 0 0 Common Stock 2022-06-03 4 A 0 266014 0 A 321962 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. Granted pursuant to the Issuer's equity incentive plan. /s/ Allen Weiss 2022-06-07