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