REQUEST FOR PROPOSALS - Westchester County Government

I certify that the names and titles of Persons Subject to Disclosure who answered “Yes” to either
of the questions above are:
1. ________________________________________________________________
2. ________________________________________________________________
3. ________________________________________________________________
4. ________________________________________________________________
5. ________________________________________________________________
(If more space is needed, please attach separate pages labeled “YES Answers -
Continued.”)
Each Person Subject to Disclosure listed above who has either been convicted of a crime(s)
and/or is subject to a pending criminal charge(s) must answer additional questions. Those
questions are below.
A Person Subject to Disclosure who has been convicted of a crime(s)
must respond to the following (please attach separate pages with responses
for each person, with their name and title):
1.) Describe the reason for being on County property if applicable,
identify the specific duties and responsibilities on this project
which you intend to perform for the County, including but not
limited to, access to sensitive data and facilities and access to
vulnerable populations.
2.) Please list all criminal convictions along with a brief description of
the crime(s) (including all felonies and misdemeanors as defined
under the New York State Penal Law or the equivalent under
Federal law or the laws of any other State).
3.) Please provide the date and place of each conviction.
4.) Please provide your age at the time of each crime for which you
were convicted.
5.) Please provide the legal disposition of each case.
6.) Please provide any information either produced by yourself or
someone on your behalf in regards to your rehabilitation and good
conduct.
A Person Subject to Disclosure who is subject to a pending criminal
charge(s) must respond to the following (please attach separate pages
with responses for each person, with their name and title):
1.) Describe the reason for being on County property and if
applicable, identify the specific duties and responsibilities on this
2