0001493152-21-029017.txt : 20211116
0001493152-21-029017.hdr.sgml : 20211116
20211116174733
ACCESSION NUMBER: 0001493152-21-029017
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211105
FILED AS OF DATE: 20211116
DATE AS OF CHANGE: 20211116
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lev Mark Toby
CENTRAL INDEX KEY: 0001878023
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40809
FILM NUMBER: 211417611
MAIL ADDRESS:
STREET 1: 70 WILLISTON RD
CITY: BROOKLINE
STATE: MA
ZIP: 02445
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/A
1
ownership.xml
X0306
4/A
2021-11-05
2021-11-09
0
0001817004
EzFill Holdings Inc
EZFL
0001878023
Lev Mark Toby
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
0
A
33763
D
On 11/05/2021, Mr. Lev 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. Lev remains a member of the Company's board of directors until such meeting.
This amendment is being filed to revise Item 4 of Table 1 to note that the price should be $0 as the shares were granted in connection with the Reporting Person's service as a member of the Company's board of directors.
/s/ Mark T. Lev
2021-11-16