0001567619-21-012719.txt : 20210629
0001567619-21-012719.hdr.sgml : 20210629
20210629171742
ACCESSION NUMBER: 0001567619-21-012719
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20210625
FILED AS OF DATE: 20210629
DATE AS OF CHANGE: 20210629
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Adjemian Kevork Tro
CENTRAL INDEX KEY: 0001869016
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39457
FILM NUMBER: 211059170
MAIL ADDRESS:
STREET 1: 1055 W. SQUARE LAKE ROAD
CITY: TROY
STATE: MI
ZIP: 48098
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Electric Last Mile Solutions, Inc.
CENTRAL INDEX KEY: 0001784168
STANDARD INDUSTRIAL CLASSIFICATION: MOTOR VEHICLES & PASSENGER CAR BODIES [3711]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1055 W. SQUARE LAKE ROAD
CITY: TROY
STATE: MI
ZIP: 48098
BUSINESS PHONE: 888-825-9111
MAIL ADDRESS:
STREET 1: 1055 W. SQUARE LAKE ROAD
CITY: TROY
STATE: MI
ZIP: 48098
FORMER COMPANY:
FORMER CONFORMED NAME: Forum Merger III Corp
DATE OF NAME CHANGE: 20190731
3
1
doc1.xml
FORM 3
X0206
3
2021-06-25
0
0001784168
Electric Last Mile Solutions, Inc.
ELMS
0001869016
Adjemian Kevork Tro
1055 W SQUARE LAKE ROAD
TROY
MI
48098
0
1
0
0
Chief Technical Officer
Convertible Note
Common Stock
55044
I
by KA Trust
On December 10, 2020, Electric Last Mile, Inc. ("ELM") entered into a $500,000 Convertible Note with KA Trust. The reporting person is the beneficial owner of the Convertible Note issued to KA Trust. Pursuant to the terms of the Convertible Note, upon the closing of the transaction contemplated pursuant to the Agreement and Plan of Merger, dated as of December 10, 2020, by and among Forum Merger III Corporation ("Forum") (upon consummation of the business combination, the surviving "Issuer" is renamed "Electric Last Mile Solutions, Inc."), ELMS Merger Corp., a wholly owned subsidiary of Forum, and ELM, as amended, the Convertible Note will be converted into shares of common stock of Electric Last Mile Solutions, Inc.
The reporting person has sole voting and investment power with respect to the shares of common stock held by the KA Trust.
/s/ Benjamin Wu, attorney-in-fact for Kevork Tro Adjemian
2021-06-29
EX-24.1
2
kadjemianpoa.txt
POWER OF ATTORNEY
POWER OF ATTORNEY
Know all by these presents, that, for good and valuable consideration, the
sufficiency and receipt of which are hereby acknowledged, the undersigned
hereby constitutes and appoints Benjamin Wu, and any of his substitutes,
signing singly, the undersigned's true and lawful attorney-in-fact to:
(I) execute for and on behalf of the undersigned (in accordance with Section
16(a) of the Securities Exchange Act of 1934, as amended, and the rules
thereunder (the "Exchange Act")), in the undersigned's capacity as an officer
and/or director of Electric Last Mile, Inc., a corporation organized under the
laws of Delaware (the "Company"), any and all Forms 3, 4 and/or 5, and any
amendments thereto, that are necessary or advisable for the undersigned to file
under Section 16(a) (collectively, "Documents");
(2) do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to complete and execute any such Documents and
timely file such Documents with the United States Securities and Exchange
Commission and any stock exchange or similar authority, including completing
and executing a Uniform Application for Access Codes to File on EDGAR on Form
ID; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of
the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such terms and conditions as such attorney-in-fact may approve in
such attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might
or could do if personally present, with full power of substitution or
revocation, hereby ratifying and confirming all that each such attorney-in-fact
(or such attorney-in-fact's substitute or substitutes) shall lawfully do or
cause to be done by virtue of this power of attorney and the rights and powers
herein granted. The undersigned acknowledges that each attorney-in-fact, in
serving in such capacity at the request of the undersigned, is not assuming,
nor is such attorney-in-fact's substitute or substitutes or the Company
assuming, any of the undersigned's responsibilities to comply with the Exchange
Act. The undersigned agrees to defend and hold harmless each attorney-in-fact
(and such attorney-in-fact's substitute or substitutes) from and against any
and all loss, damage or liability that such attorney-in-fact may sustain as a
result of any action taken in good faith hereunder.
This Power of Attorney revokes any power of attorney previously executed by the
undersigned with respect to the foregoing subject matter. This Power of
Attorney shall remain in full force and effect until the undersigned is no
longer required to file Documents with respect to the undersigned's holdings of
and transactions in securities issued by the Company, unless earlier revoked by
the undersigned in a signed writing delivered to each of the foregoing
attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 27th day of June, 2021.
/s/ Kevork T. Adjemian
Kevork T. Adjemian