1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Convertible Promissory Note
|
06/08/2020 |
(1)
|
Common Stock
|
120,000
(2)
|
$
2.5
|
I
|
Sky Startups, LLC
|
Convertible Promissory Note
|
06/08/2020 |
(1)
|
Common Stock
|
122,634
|
$
0.5
|
I
|
Siena Properties, LLC
|
8% Series A-1 Preferred Stock
|
09/08/2020 |
(3)
|
Common Stock
|
118,909
(4)
|
$
(4)
|
I
|
Siena Properties, LLC / SOBR Safe, LLC
(5)
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
The promissory note does not expire. |
(2) |
The Reporting Person owns 94.242% of Sky Startups, LLC. Sky Startups, LLC can convert its promissory note into 120,000 shares of the Issuer's common stock. The entire amount of shares that could be issued to Sky Startups, LLC is listed on this Form 3. |
(3) |
The 8% Series A-1 Convertible Preferred Stock does not have an expiration date. |
(4) |
The number of shares is variable based on the average closing price of the Issuer's common stock. The 118,909 shares is estimated based on the closing stock price of $2.75 on December 18, 2020. |
(5) |
Siena Properties, LLC, an entity owned by the Reporting Person, owns 5% of SOBR Safe, LLC, which owns the 8% Series A-1 Convertible Preferred Stock of the Issuer. The number of shares shown on the Form 3 is only the estimated number of shares of the Issuer's common stock Siena Properties, LLC would be entitled to upon conversion of the 8% Series A-1 Convertible Preferred Stock. |