0001493152-23-020288.txt : 20230606 0001493152-23-020288.hdr.sgml : 20230606 20230606161302 ACCESSION NUMBER: 0001493152-23-020288 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230602 FILED AS OF DATE: 20230606 DATE AS OF CHANGE: 20230606 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Arbour Daniel Ronald CENTRAL INDEX KEY: 0001966052 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40809 FILM NUMBER: 23996203 MAIL ADDRESS: STREET 1: 435 CHEMIN DU REFUGE CITY: LAC SUPERIEUR STATE: A8 ZIP: J0T 1P0 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: 2999 NE 191ST STREET STREET 2: SUITE 500 CITY: AVENTURA STATE: FL ZIP: 33180 BUSINESS PHONE: 305-791-1169 MAIL ADDRESS: STREET 1: 2999 NE 191ST STREET STREET 2: SUITE 500 CITY: AVENTURA STATE: FL ZIP: 33180 4 1 ownership.xml X0407 4 2023-06-02 0 0001817004 EzFill Holdings Inc EZFL 0001966052 Arbour Daniel Ronald C/O EZFILL HOLDINGS INC. 2999 NE 191ST STREET AVENTURA FL 33180 1 0 0 0 0 Common Stock 2023-06-02 4 A 0 58824 0 A 69241 D The shares will fully vest in 12 months from the grant date. 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 number of shares is based on $130,000 per the Issuer's director compensation agreement with the Reporting Person and the closing price $2.21 on June 2, 2023. Granted pursuant to the EzFill Holdings, Inc. 2023 Equity Incentive Plan. The number of shares reflects a one-for-eight reverse split effective on April 27, 2023. /s/ Daniel Arbour 2023-06-06