APPENDIX A: INVESTMENT FIRM CERTIFICATION FORM

   CITY OF BLUE ISLAND, ILLINOIS

   DIRECTOR OF FINANCE

   INVESTMENT FIRM CERTIFICATION FORM

As an authorized account representative for _______________________________________________, I hereby certify that I have personally read and understand the investment policies of the City of Blue Island, Illinois, in such form as said policies of the City were provided to me. I agree to abide by said policy in all transactions between myself, on behalf of the above referenced firm, and the City and further agree to undertake reasonable efforts to preclude imprudent transactions involving the City’s funds.

Authorized Account Representative

______________________________________         ________________________________________

(Signature)                              (Title)

______________________________________         ________________________________________

(Name - Printed)                           (Date)

(Prior Code, Ch. 38, App. A) (Ord. 99-286, passed 12-14-1999)