Certification For Replacement
Soft Body Armor Vest Containing Zylon
I, ___________________________, [TITLE] ____________________, hereby
certify that I am requesting reimbursement for funds under Executive Law Section 837-d,
“Soft body ballistic armor vests for police officers” in order to replace a soft body armor
vest containing Zylon. I certify that the vest which is being replaced was purchased for
__________________________, who is a police officer, as defined in subdivision thirty-
four of section 1.20 of the Criminal Procedure Law, and whose regular duties are such as
may expose him/her/me to serious physical injury which may result in death or disability.
I further certify that the reimbursement requested under Executive Law Section 837-d is
in addition to and does not duplicate any reimbursement received from the federal Bullet
Proof Vest Partnership Program and the manufacturer or the distributor of the original
defective vest containing Zylon. The following is additional information which identifies
the vest containing Zylon which is being replaced.
[Insert identifying information such as serial number, manufacturer, size, etc.]
Dated: __________________, New York