PAGE 1 OF 5
ATTACHMENT NO. 4
CITY OF NORWALK
BROKER/DEALER QUESTIONNAIRE AND CERTIFICATION
1. Name of Firm:
2. Address:
3. Telephone:
4. Broker’s Representative to the City (attach resume)
Name:
Title:
Telephone:
5. Manager/Partner-in-Charge (attach resume)
Name:
Title:
Telephone:
6. List all personnel who will be trading with or quoting securities to City employees (attach resume)
Name:
Title:
Telephone:
7. (a) Which of the above personnel have read the City’s investment policy?
(b)
Do each of the foregoing individuals currently hold valid licenses to trade securities on behalf of the City?
Yes No
PAGE 2 OF 5
City of Norwalk
Broker/Dealer Questionnaire and Certification
Name of Firm:
Page Two
8. Is your firm a primary dealer in United States Government Securities?
Yes No
9. List the total volume of United States Government and Agency Securities for the last calendar year.
Firm-wide $ No. of Transactions
Your local office $ No. of Transactions
10. Which instruments are offered regularly by your local office?
Treasury Bills CMO’s
Treasury Notes/Bonds Bank CD’s
BA’s (domestic) S & L CD’s
BA’s (foreign) Repos
Commercial Paper Reverse Repos
Agencies (specify) Other (specify)
11. References – Please identify your most directly comparable public sector clients in our geographical area.
Entity
Contact
Telephone
Client since
City of Norwalk
PAGE 3 OF 5
Broker/Dealer Questionnaire and Certification
Name of Firm:
Page Three
12. Have any of your clients ever sustained a loss on a securities transaction arising from a misunderstanding or misrepresentation of the risk characteristics of the instrument? If so, explain.
13. Has your local office ever subject to a regulatory or state/federal agency investigation for alleged improper, fraudulent, disreputable or unfair activities related to the sale of securities? Have any of your employees been so investigated? If so, explain.
14. Has a client ever claimed in writing that your firm was responsible for investment losses? If so, explain.
15. Explain your normal custody and delivery process. Who audits these fiduciary systems? Can you meet safekeeping requirements?
City of Norwalk
PAGE 4 OF 5
Broker/Dealer Questionnaire and Certification
Name of Firm:
Page Four
16. How many and what percentage of your transactions failed last month?
Las Year?
17. Describe the capital line and trading limits of the office that would conduct business with the City of Norwalk.
18. Does your firm participate in the S.P.I.C. insurance program? If not, explain.
19. What portfolio information, if any, do you require from your clients?
20. What reports, transactions, confirmations and paper trail will the City receive?
21. Does your firm offer investment training to your clients?
Yes No
City of Norwalk
Broker/Dealer Questionnaire and Certification
Name of Firm:
PAGE 5 OF 5
Page Five
22. Please enclose the following:
Latest audited financial statements.
Samples of reports, transactions, and confirmations the City will receive.
Samples of research reports and/or publications that your firm regularly provides to clients.
Complete schedule of fees and charges for various transactions.
***CERTIFICATION***
I hereby certify that I have personally read the Statement of Investment Policy of the City of Norwalk and have implemented reasonable procedures and a system of controls designed to preclude imprudent investment activities arising out of transactions conducted between our firm and the City of Norwalk. All sales personnel will be routinely informed of the City’s investment objectives, horizons, outlooks, strategies and risk constraints whenever we are so advised by the City. We pledge to exercise due diligence in informing the City of Norwalk of all foreseeable risks associated with financial transactions conducted with our firm. Under penalties of perjury, the responses to this questionnaire are true and accurate to the best of my knowledge.
Signed Date
Title
Countersignature* Date
Title
* Company president or person in charge of government securities operations.