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This PDF document presents the information and questions currently expected to be included in the CERTS quarterly report (report), 

which will be made available to Grantees through the on-line CERTS portal after December 31, 2021. 

The purpose of this PDF document is to allow Grantees to familiarize themselves with the expected reporting requirements, and to 

allow Grantees to submit questions to Treasury about the report before it goes live in the CERTS portal after December 31, 2021. 

Grantees may submit questions about completing this report to CERTS@treasury.gov. 

To the extent that questions relate to CERTS program obligations and requirements, Treasury encourages Grantees to review their 

Grant Agreement and check the Frequently Asked Questions (FAQ) and guidance on the CERTS homepage on Treasury.gov before 

submitting questions. 

Treasury may make changes or clarifications to the report based on Grantee questions, and prior to December 31, 2021 Treasury 

expects to publish a new FAQ document to address the most common issues raised by Grantees. 

OMB Control Number: 1505-0273 

PRA Burden Statement 

The information collected in this application will be used by the U.S. Government to process requests for financial support. An agency may not conduct or sponsor, and a person is 

not required to respond to, a collection of information unless it displays a valid control number assigned by OMB. The estimated burden associated with this collection of 

information is 1.5 hours per response. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Office of 

Privacy, Transparency, and Records, U.S. Department of the Treasury, 1500 Pennsylvania 
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Instructions Tab 

Instructions 

Welcome to the U.S. Department of the Treasury Quarterly Report portal for Grantees of the Coronavirus Economic Relief for 

Transportation Services (CERTS) program. Each Grantee is required by the Grant Agreement entered into between the Grantee and 

Treasury to submit a certified Quarterly Report regarding compliance with the Grant Agreement and the CERTS statute (section 421 

of Division N, Title IV, Subtitle B of the Consolidated Appropriations Act, 2021). 

The first Quarterly Report must be submitted by the February 15, 2022. The first Quarterly Report covers Grantee activity from the 

effective date of the Grant Agreement (i.e., the date Treasury signed the Grant Agreement) through December 31, 2021. 

Please read the on-screen instructions carefully for each element of the Quarterly Report. In addition, you should review the 

Frequently Asked Questions (FAQ) document on the CERTS homepage on Treasury.gov. The FAQ has numerous answers to 

questions on the eligible use of funds. If after reviewing the on-screen instructions and the FAQ, you still have questions about 

completing the Quarterly Report, you may email CERTS@Treasury.gov. However, each Grantee is responsible for submitting its 

Quarterly Report by the deadline, regardless of whether it has a question pending with the Treasury at the time of the deadline. 

Grantees must use available information, records, and reasonable judgment to submit the Quarterly Report by the deadline. 

Navigation 

The Quarterly Report has nine sections. You can navigate among the sections using the banner on the left side of the screen. You have 

the option to save your work within each section and return to complete the Report later, but in no case later than the deadline. You 

will not be able to submit the Report until all mandatory fields and uploads are complete, as indicated by the on-screen prompts. 

Clicking the "Submit" button on the Certified Submission tab will finalize and submit the Report, and you will not be allowed to edit 

your Report after the deadline without prior approval of Treasury staff. Treasury will post instructions on the CERTS homepage on 

Treasury.gov for Grantees that may need to change their Report after the deadline. 

Information Requested 

Grantees will generally need the Grant Agreement, payment and banking records, and payroll reports to complete the Quarterly 

Report. Please begin by confirming that the pre-populated information on the Verification of Grantee Information tab is accurate, and 

then complete each of the remaining sections, as applicable. 

Please note that, in satisfying documentation requirements for expenditures, grantees must follow the requirements in the Grant 

Agreement in Paragraph 21 – Accuracy and Traceability, Paragraph 22 – Internal Controls, and Paragraph 23 – Records Retention. 
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Certification and Representation 

Grantees must conduct a reasonable inquiry of their staff and records prior to completing the Report and certifying as to the accuracy 

of the contents of the Report, including the required certifications. Consistent with the Grant Agreement, submission of this Quarterly 

Report constitutes a certification by the Grantee that the Grantee is in compliance with the Grant Agreement and that all data and 

information included in the Report are true and correct and do not contain any materially false, fictitious, or fraudulent statements. The 

report must include the name and contact information of the authorized company official who is certifying the information in this 

report. 

Quarterly Report aggregate information on recalls, rehires, expenditure by category, and restoration of service may be made available 

on Treasury.gov and other official federal web pages for federal spending transparency purposes and may be made available to the 

Treasury Office of Inspector General and/or the Government Accountability Office. 

The failure to file a report by the required deadline may result in administrative remedies, including but not limited to the recovery of 

CERTS Funds. Please see the section on the Grant Agreement regarding “Noncompliance and Remedies.” False, fictitious, or 

fraudulent statements provided in the reports may result in such administrative remedies as well as civil penalties and/or criminal 

prosecution and penalties. 

Treasury seeks to promote voluntary compliance. Thank you for your cooperation.

Future Reporting Periods and Deadlines

As noted above, the due date for the first Quarterly Report is February 15, 2022, covering activity from the effective date of the Grant 

Agreement through December 31, 2021. Grantees have 45 days after December 31, 2021 to submit the first Quarterly Report. This 

45-day period will provide Grantees the opportunity to familiarize themselves with the quarterly reporting process and ask questions 

and allow time for Treasury to respond to questions. 

Future Quarterly Report deadlines will be 15 days after each calendar year quarter, unless that day is not a business day, in which case 

the due date will fall on the next business day. The due dates and reporting periods are as follows: 

 

February 15, 2022 - initial filings covering Grant Agreement date through December 30, 2021, 

April 15, 2022 - first quarter reports covering January 1 through March 31, 2022, 

July 15, 2022 for second quarter reports covering April 1 through June 30, 2022, and 

October 17, 2022 for third quarter reports covering activity from July 1 through September 30, 2022. 
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Section 1: Verification of Grantee Information 

(Grantee Validation of Information that will be Presented to the Grantee by the System) 

Please review the following information to verify that it is correct. 

Official Grantee Name Grantee Name

CERTS Number Grantee’s CERTS Number

Initial Payment Amount $$$

Amount Withheld from Initial Payment * $$$

Second Payment Amount $$$

Amount Withheld from Second Payment * $$$

Net Amount Paid to Grantee $$$

* If the amount entered for this line on is more than “0,” then the Grantee had a portion of its grant payment reduced or 

withheld through an offset process to collect delinquent debts owed to the Federal Government or a State Government. 

This process did not change the official amount of the grant award, but it did reduce the amount of the payment(s) sent to 

the Grantee. See Question #17 of the CERTS FAQ for more information.

Please use this text box to correct any information above that is inaccurate. Please clearly indicate what field is incorrect, provide the 

correct information, and explain why you think the information needs correction. Treasury will review proposed corrections and will 

accept them at Treasury’s discretion. 

Text box for Grantee to enter corrections to Grantee information 

 
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Section 2: Total Funds Used On or Before December 31, 2021 

(Grantee to Enter One Total Number)

Out of the $[system will show amount paid to Grantee] paid to the Grantee, please enter the total amount of funds that were used or 

spent for program purposes on or before December 31, 2021. Amounts spent for program purposes are any and all transactions 

representing an eligible use of funds under Sections 1 through 3 of the Grant Agreement, including funds spent by the Grantee for 

operating expenses, funds transferred to any subsidiary that used the funds for operating expenses, and funds paid to reimburse a 

subsidiary or affiliate for payroll costs or eligible services rendered. 

Numeric box for Grantee to enter amount spent on or before December 31, 2021

Note: Amounts simply transferred to an account of a subsidiary or affiliate, but not yet expended by the subsidiary or affiliate for program purposes, should not be included in the amount entered. 

However, amounts paid to a subsidiary or affiliate as compensation for their actual payroll costs, or for eligible services or goods rendered to the Grantee, are considered to have been expended for 

program purposes and should be included in the amount entered. 

Based on the amount Treasury paid to you, and the amount you spent for program purposes on or before December 31, 2021, you had 

$[system will calculate difference between net amount paid and amount Grantee entered above] of grant funds remaining on January 

1, 2022. 

 
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Section 3: Organizational Use of Funds 

(Interactive Table for Grantee to Enter Names of Any Subsidiaries or Affiliates that Received Funds) 

The CERTS grant agreement allows the Grantee to use funds for its own eligible operating expenses, or for eligible operating 

expenses related to certain activities of subsidiaries and affiliates. In this section, you must identify any subsidiaries or affiliates to 

whom the Grantee transferred or paid funds. 

The following terms are defined in the CERTS Grant Agreement. 

 The Grantee is the corporate entity that signed the CERTS Grant Agreement. 

 There are two types of subsidiaries. A Covered Subsidiary of the Grantee is an entity controlled by the Grantee and whose items 

of income or deduction, if any, are reflected in the tax returns of the Grantee, including any entity that is disregarded from the 

Grantee for Federal income tax purposes. An Independent Subsidiary of the Grantee is an entity that is controlled by the Grantee 

but files its own Federal tax returns or whose income or deductions, if any, are reflected in the Federal tax return of a company 

other than the Grantee. 

 An Affiliate of the Grantee (for purposes of CERTS) includes the Grantee’s parent company and a corporate entity that is under a 

parent company’s common control with the Grantee. 

To ensure compliance with the grant agreement, the Grantee (insert name and TIN) must enter into the table below the name and TIN 

of any Covered Subsidiary, Independent Subsidiary, or Affiliate in its corporate family that used or received any CERTS funds under 

the following circumstances: 

 Grantee Transferred Funds to Subsidiary: provide the name and TIN of any subsidiary to whom the Grantee transferred funds 

for use by the subsidiary for the subsidiary’s own eligible operating expenses, such as the subsidiary’s own payroll or operations 

and maintenance expenses. 

 Grantee Pays or Reimburses Subsidiary or Affiliate for Payroll Costs: provide the name and TIN of any subsidiary or affiliate 

to whom the Grantee paid or reimbursed funds for payroll costs related to employees of the subsidiary or affiliate that performed 

necessary operating functions for the Grantee. 

 Grantee Paid Funds to Subsidiary or Affiliate for Services Rendered: provide the name and TIN of any subsidiary or affiliate 

to whom the Grantee paid funds for the acquisition of services or goods sold by the subsidiary or affiliate to the Grantee under 

ordinary course terms. 
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Later in this report you will be required to enter the amount of funds transferred or paid to each subsidiary or affiliate. In the table 

below, simply provide the name and TIN of each subsidiary and affiliate that received any funds. Enter the name and TIN of a 

subsidiary or affiliate only once in the table, even if it received multiple types of transfers or payments. 

If you are a Grantee that is a stand-alone company that does not have any subsidiaries or affiliates, or if you are a Grantee 

that did not transfer or pay any funds to any subsidiary or affiliate, please check this box [box check] and move to the next 

section without entering anything into the table below. 

Form Input for Grantee to enter names and TINs of subsidiaries and affiliates receiving funds from the Grantee 

ENTITY ENTITY TIN

Subsidiary / Affiliate 1 TIN

Subsidiary / Affiliate 2 TIN

+ Button to add rows to table for additional names

 
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Section 4: Detail on Use of Funds 

(Interactive Table for Grantee to Enter Amounts for Each Eligible Use Category) 

Under the CERTS statute, there are seven categories of eligible operating expenses. 

1. Employee Payroll 

2. Independent Contractor Payroll 

3. Sole Proprietor Payroll 

4. Repayment of Debt Accrued to Maintain Payroll During the Pandemic 

5. Services and Equipment to Protect Workers and Customers from COVID-19 

6. Operations and Maintenance of Existing Facilities and Equipment 

7. Restored Compensation of Lost Pay and Benefits for Rehired Employees 

In the table below, for each of the seven eligible categories, you must enter the amount of funds spent by the Grantee itself for its own 

eligible operating expenses on or before December 31, 2021, and the amount of funds transferred to, paid to, or used by each 

subsidiary and affiliate you identified in Section 3 “Organizational Use of Funds,” on or before December 31, 2021. 

Please make sure you do not “double count” any amounts by entering the same dollars under both the Grantee and a subsidiary or 

affiliate. To be clear, if the Grantee transferred or paid funds to a subsidiary or affiliate, those funds should be reported by the name of 

the subsidiary or affiliate and should not be reported by the name of the Grantee. Amounts listed for the Grantee should include only 

operating expenses that did not involve a payment or transfer to a subsidiary or affiliate. 

Further, amounts simply transferred to an account of a subsidiary or affiliate, but not yet expended by the subsidiary or affiliate for 

program purposes by December 31, 2021, should not be included in any amounts entered, since the funds were not spent. However, 

amounts paid as compensation to a subsidiary or affiliate for its actual payroll costs or for services or goods rendered to the Grantee 

are considered to have been expended for program purposes and should be included in the amounts entered. 

If the Grantee or a subsidiary or affiliate does not have expenditures related to a particular category or column, you may leave the field 

blank or enter “0.” 

The grand total for all amounts in the table should equal $[system will insert Grantee’s answer to the first question on amount spent on 

or before Dec 31], which you entered in response to the first question in Section 1 “Funds Used On or Before December 31, 2021.” 
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Editable Link Table for Grantee to enter amounts for eligible spending categories by the Grantee and any subsidiaries and affiliates 

receiving funds. Table will be pre-populated with the names of any subsidiaries and affiliates identified by the Grantee in Section 2 

“Organizational Use of Funds.” If the Grantee has no subsidiaries or affiliates, or indicated it did not transfer or pay any funds to 

any subsidiary of affiliate, table will show only one row for the Grantee. 

Entity 

Employee 

Payroll 

Independent

Contractor 

Payroll 

Sole 

Proprietor

Payroll 

Debt 

Accrued 

for Payroll 

COVID-19 

Protection 

Operations & 

Maintenance 

Restored 

Compensation TOTAL

Grantee Calculated 

Sum

Subsidiary Calculated 

Sum

Affiliate Calculated 

Sum

Etc. as needed Calculated 

Sum

TOTAL Calculated 

Sum

Calculated 

Sum

Calculated 

Sum

Calculated 

Sum

Calculated 

Sum

Calculated 

Sum

Calculated 

Sum

Calculated 

Sum

Based on the information you entered in the table above, payroll costs represent [system calculated percent] % of the total amount 

spent through December 31, 2021. 

 
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Section 5: Recalls & Rehires Certification 

The CERTS statute provides that, 30 days after a Grantee first receives funds from Treasury, a Grantee must recall or rehire any 

employees laid off, furloughed, or terminated after March 27, 2020, to the extent warranted by increased service levels. More 

information on this requirement is available here: https://home.treasury.gov/system/files/136/CERTS-Employee-Recall-and-RehireInformation.pdf

This recall or rehire provision does not apply to employees terminated for cause, or to seasonal employees that were terminated after 

the season. 

Under the terms of the CERTS Grant Agreement, this recall and rehire provision applies to the Grantee, Covered Subsidiaries of the 

Grantee (if any), and Independent Subsidiaries of the Grantee that received CERTS funds from the Grantee (if any). Please remember 

the definitions for these terms included in the previous section: 

 The Grantee is the corporate entity that signed the CERTS Grant Agreement. 

 A Covered Subsidiary of the Grantee is an entity controlled by the Grantee whose income or deductions, if any, are reflected in 

the tax returns of the Grantee, including any entity that is disregarded from the Grantee for Federal income tax purposes. 

 An Independent Subsidiary of the Grantee is an entity controlled by the Grantee but files its own Federal tax return or whose 

income or deductions, if any, are reflected in the Federal tax return of a company other than the Grantee. 

(Independent Subsidiaries that did not receive CERTS funds from the Grantee are NOT subject to this recall and rehire 

certification; only Independent Subsidiaries that received CERTS funds from the Grantee are subject to this certification). 

An authorized company official must certify the Grantee’s recall and rehire activities, consistent with the CERTS Act. Therefore, 

please select one of the three certification options below that matches your recall and rehire activities. In making your selection and 

certification, remember that your certification covers the Grantee, all Covered Subsidiaries of the Grantee (if any), and any 

Independent Subsidiaries of the Grantee that received CERTS funds from the Grantee (if any). 

1. My company did not involuntarily terminate or furlough employees after March 27, 2020. [Picklist (Yes,No)] 

 

2. My company involuntarily terminated or furloughed employees after March 27, 2020, but we rehired employees before we received 

CERTS funds. 

3. After receiving CERTS funds, my company deemed that its service levels did not warrant the recall of any employees involuntarily 

terminated or furloughed after March 27, 2020. [Picklist (Yes,No)] 
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Note that only one of the four check boxes can be selected by the system. 

4. After receiving CERTS funds, my company deemed that its service levels warranted the recall of some or all the employees it 

involuntarily terminated or furloughed. [Picklist (Yes,No)] 

Below are two additional questions that will be shown ONLY by Grantees that certified to option 3. 

4.i Please enter the total number of U.S.-based employees re-hired after signing the Grant Agreement. 

Numeric box for Grantee to enter number of employees

4.ii Please enter the total number of U.S.-based employees to whom recall notices were issued after signing the Grant Agreement but 

who decided not to return to work. 

Numeric box for Grantee to enter number of employees

 
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Section 6: Other Certifications 

An authorized company official must certify compliance with the statements in this Section. Certify your compliance by selecting the 

“YES” option next to a statement. If you cannot certify your compliance with any of the statements in this section, you may select the 

“NO” option next to the relevant statement, and Treasury will contact you to for additional facts and information. 

Some of these certification statements make reference to the Grantee, Covered Subsidiaries of the Grantee (if any), Independent 

Subsidiaries of the Grantee (if any), and Affiliates of the Grantee (if any). Once again, please remember the definitions of these terms 

from previous sections: 

 The Grantee is the corporate entity that signed the CERTS Grant Agreement. 

 A Covered Subsidiary of the Grantee is an entity controlled by the Grantee whose items of income or deduction, if any, are 

reflected in the tax returns of the Grantee, including any entity that is disregarded from the Grantee for Federal income tax 

purposes. 

 An Independent Subsidiary of the Grantee is an entity that is controlled by the Grantee but files its own Federal tax returns or 

whose income or deductions, if any, are reflected in the Federal tax return of a company other than the Grantee. (Only 

Independent Subsidiaries that received CERTS funds from the Grantee may be subject to a certification below. Independent 

Subsidiaries that did not receive CERTS funds from the Grantee are NOT subject to any certifications.) 

 An Affiliate of the Grantee includes the Grantee’s parent company and a corporate entity that is under a parent company’s 

common control with the Grantee. (Only Affiliates that received CERTS funds from the Grantee may be subject to a certification 

below. Affiliates that did not receive CERTS funds from the Grantee are NOT subject to any certifications.) 

Please read each statement carefully before making your certification. 

1. Only Eligible Use of Funds: I certify that all CERTS funds were used for eligible purposes only and were NOT used for 

ineligible expenses including, but not limited to, capital expenditures, any Federal payroll taxes, compensation to any individual in 

excess of annual rate of $100,000, any bonuses, and raises above the rate of inflation. [Picklist (The Grantee certifies, The 

Grantee does NOT certify)] 

2. Adherence to Grant Agreement. I certify that the Grantee has been in compliance with the terms and conditions of the Grant 

Agreement from the effective date of the Grant Agreement (the date of Treasury’s signature on the Grant Agreement) through and 

including December 31, 2021. [Picklist (The Grantee certifies, The Grantee does NOT certify)] 
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3. Prohibited Practices: I certify that neither the Grantee nor any Covered Subsidiaries, Independent Subsidiaries that received any 

funds from the Grantee, or Affiliates that received funds for payroll costs imposed any involuntary terminations or furloughs or 

imposed a reduction in the rate of pay of salary and wages or in benefits in violation of paragraphs 9 and 10 of the Grant 

Agreement. [Picklist (The Grantee certifies, The Grantee does NOT certify)] 

Certification 4 will be presented ONLY to Grantees that reported using funds for the restoration of lost pay and benefits to employees 

that had been previously furloughed. 

4. Restored Pay (Offset): I certify that, in using CERTS funds to compensate returning employees for lost pay and benefits during 

the COVID-19 pandemic, the Grantee or its Covered Subsidiary, as applicable, offset the compensation provided to the returning 

employees for lost pay and benefits by (1) any amounts Grantee or its Covered Subsidiary paid the employee furlough pay, 

severance pay, or separation pay as a result of the layoff, furlough, or termination of the employee or any failure to hire the 

employee for seasonal employment during calendar year 2020, and (2) and any amounts the employee received from 

unemployment insurance. [Picklist (The Grantee certifies, The Grantee does NOT certify)] 

Certification 5 will be presented ONLY to Grantees that reported transferring funds to Affiliates.

5. Compliance by Affiliates that Received Funds: I certify that each Affiliate of the Grantee that has received funds as payment or 

reimbursement for its payroll costs in support of the Grantee has agreed with the Grantee that the Affiliate will (a) comply with the 

provisions of paragraphs 9 through 11 of the Grant Agreement with respect to employees whose payroll costs were covered using 

the funds, (b) provide the Grantee with the information necessary to complete the Grantee’s quarterly reports to Treasury, (c) 

maintain records as required by the Grant Agreement, and (d) provide the Grantee with such other information as necessary for the 

Grantee to comply with the terms of the Grant Agreement. [Picklist (The Grantee certifies, The Grantee does NOT certify)] 

Certification 6 will be presented ONLY to Grantees that reported less than 60% of their eligible expenditures were for payroll costs. 

6. Priority Use of Funds for Payroll. Based on the amounts you entered for the different categories of eligible expenses, the 

Grantee and its subsidiaries used less than 60 percent of the funds on payroll costs. In accordance with paragraph 6 of the Grant 

Agreement, you may use less than 60 percent of funds for payroll costs if you certify to the following statement. I certify that, 

after making any adjustments required for retirement or voluntary employee separation, the Grantee and its Covered Subsidiaries: 

 Have rehired, or offered to rehire, any nonseasonal employee on the payroll on January 1, 2020, that was laid off, furloughed, 

or terminated after March 27, 2020, at no less than 100 percent of the employee’s previous salary; and 

 Have re-established, at no less than 100 percent of the previous salary, the salary of any employee that was first laid off, 

furloughed, or terminated after March 27, 2020, and subsequently rehired at a reduced salary before the date on which the 

Grantee first receives Funds from Treasury under this Grant Agreement; and 
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 Are staffed at a level of full-time equivalent, seasonal employees, on a monthly basis, that is equal to or greater than the level 

at which the Grantee and its Covered Subsidiaries were staffed with full-time equivalent, seasonal employees on a monthly 

basis during calendar year 2019; and 

 Have offered priority in rehiring to any seasonal employee that was laid off, furloughed, terminated, or not offered rehire in 

calendar year 2020, as the Grantee achieves staffing that is equal to greater than the level of fulltime equivalent, seasonal 

employees, on a monthly basis during calendar year 2019; and 

 Have offered no less than 100 percent of previous salary to any seasonal employee (a) that is rehired after being laid off, 

furloughed, terminated, or not offered rehire in calendar year 2020, or (b) that was subject to a reduction in salary before the 

date on which the Grantee first receives Funds from Treasury under this Grant Agreement; and 

 Will fully pay, until all CERTS funds have been expended, all Payroll Costs associated with any seasonal and nonseasonal 

employees described in this certification. [Picklist (The Grantee certifies, The Grantee does NOT certify)] 
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Section 7: Changes in Control, Bankruptcy, and Legal Actions 

(Grantees Answer YES or NO Questions About Corporate Events)

To ensure compliance with the Grant Agreement, Treasury needs current information on the ownership and control of the Grantee, 

and current information on whether the Grantee is involved in any new criminal cases or certain civil lawsuits. Any change in 

ownership or control, and certain new legal actions, involving the Grantee after entering into the Grant Agreement could affect or 

change the official corporate entity or entities that are subject to the terms of the Grant Agreement. In addition, Treasury needs to 

know if the Grantee or any subsidiaries or affiliates of the Grantee have become a debtor in a bankruptcy proceeding after the Grantee 

entered into the Grant Agreement and received funds, which could affect the terms and conditions of the Grant Agreement. 

Therefore, please answer the following three questions by selecting “YES” or “NO.” The first two questions apply to the Grantee, and 

the third question applies not only to the Grantee but also to any subsidiaries or affiliates of the Grantee. 

If you select the “YES” option, you must provide additional information to explain each event that has occurred since signing the 

Grant Agreement. If you select the “NO” option indicating no event has occurred, you do not need to provide any additional 

information. 

Change in Control: Since entering into the Grant Agreement, has the Grantee engaged in, or entered into an agreement to engage in, 

a merger transaction or a transaction involving the sale or transfer of all or substantially all of its assets to another company? [YES / 

NO Selection] 

If “YES,” please briefly describe the change and whether it has or will result in a name change to the corporate entity that is party to 

the Grant Agreement. Treasury may contact you to request additional information and documentation. 

If “YES,” text box for grantee to describe the change in control 

Criminal or Civil Legal Actions: Since entering into the Grant Agreement, has any Federal or State government agency filed or 

resolved: (a) any criminal case or (b) a civil lawsuit based on allegations of false statements, fraud, or other untruthfulness against the 

Grantee or any owner or Executive Employee of the Grantee? 
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If “YES,” please briefly describe the status of the relevant criminal and/or civil proceedings and upload any relevant indictment, 

criminal information, plea agreement, civil complaint, settlement agreement, consent decree, or similar document. Treasury may 

contact you to request additional information and documentation. [YES / NO Selection] 

If “YES,” text box for grantee to describe the bankruptcy proceeding 

If “YES,” upload button for grantee to upload associated documents

Bankruptcy: Has the Grantee or any subsidiary or affiliate of the Grantee become a debtor in a proceeding filed under the United 

States Bankruptcy Code, whether the bankruptcy proceeding is voluntary or involuntary? [YES / NO Selection] 

If “YES,” please briefly describe the status of the bankruptcy proceeding and explain whether the proceeding is voluntary or 

involuntary. Treasury may contact you to request additional information and documentation. 

If “YES,” text box for grantee to describe the bankruptcy proceeding 

 
17 

Section 8: Feedback

Responses in this section will be used to evaluate the overall effectiveness of the CERTS program and will not be used to evaluate the 

Grantee’s compliance with the program’s legal requirements. Treasury values feedback from Grantees. 

Please complete the following three feedback questions by selecting answers from the dropdown menus. 

Overall, how effective was the CERTS program in helping the Grantee’s organization to restore services reduced due to COVID-19, 

including, where applicable, covering payroll and operational expenses? 

Dropdown menu options: 

 No Response 

 Very Ineffective 

 Ineffective 

 Effective 

 Very Effective

How was the Grantee organization’s overall experience using the CERTS on-line portal? 

Dropdown menu options: 

 No Response 

 Very Ineffective 

 Ineffective 

 Effective 

 Very Effective

 
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Using your pre-pandemic levels of service activity in 2019 as the baseline, what was the peak level of transportation service activity 

that your company achieved in Q3/Q4 of calendar year 2021? 

Dropdown menu options: 

 Less than 50% of the 2019 baseline level 

 Between 50% and 75% of the 2019 baseline level 

 Between 75% and 100% of the 2019 baseline level 

 Above 2019 levels 

 Significantly above 2019 levels

Please use the space below to provide any other feedback or comments to Treasury about the CERTS program and your experience as 

a Grantee. 

Text box for Grantee to enter any other feedback 
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Section 9: Submission of Report 

(Authorized Official Signs Report) 

Consistent with and pursuant to your Grant Agreement, submission of this Quarterly Report constitutes a certification by the Grantee 

that the Grantee is in compliance with the Grant Agreement and that all data and information included in the Report are true and 

correct and do not contain any materially false, fictitious, or fraudulent statements. 

Any materially false, fictitious, or fraudulent statement (or concealment or omission of material fact) in this Quarterly Report may be 

the subject of criminal prosecution and also may subject the Grantee to civil penalties and/or administrative remedies for false claims 

or otherwise. 

Please enter the name, title, and email address of the Grantee’s authorized company official who signed the Grant Agreement, to 

confirm that person’s role for the Treasury records, then click the Button to Submit Report. If your authorized company official has 

changed since the signing of the Grant Agreement, please enter the updated information, then click the Button to Submit Report. 

Text boxes to enter authorized company official information

Name 

Title 

Email

Button to Submit Report