Aeroplane
Make:	Quad City Ultralight Aircraft Corp.	Manufacturer:	Quad City Ultralight Aircraft Corp.
Model:	Challenger II	Address:	Box 370
Serial:	CH2___________________		Moline, IL 61266-0370

I certify that the airplane referred to herein has been assembled from a kit for which a Declaration of Compliance is in effect, that it has been assembled in accordance with the manufacturer's instructions, that it has not been modified without the manufacturer's written permission, and that all Mandatory Actions have been completed.

I further certify that this airplane has never moved under its own power with the intention of flight and that it has not been involved in any sort of shipping, handling, building, moving or other incident which could have resulted in damage which would impair the safe operation of the airplane.

I hereby acknowledge that the inspection of this airplane for purposes of signing the Transport Canada mandated Statement of Conformity has been completed by ____________________________________, hereinafter known as the Inspector, and that the Inspector has signed said Statement of Conformity solely on the basis of my certification in the two paragraphs immediately preceding this one.

I further acknowledge that such examinations and tests the Inspector deemed appropriate to perform are a subset of all possible examinations and tests and I acknowledge that they do not represent an exhaustive and complete check of all aircraft components and systems. I also acknowledge that many components of the aircraft were not visible to the Inspector at the time of the inspection because they had been covered by fabric or had otherwise been obscured by the assembly process.

I hereby commit to have the airplane subjected to a suitable final inspection by a competent party prior to the first flight in order to ensure that the airplane is in fact ready and safe for such flight. I further commit to have said initial flight testing performed by a pilot suitably experienced in the flight characteristics of this airplane. I also commit to ensure that all pilots flying the airplane while the airplane is in my custody and control will be given appropriate instruction in the operation of the airplane.

I state that I understand that operating and flying an airplane can be hazardous and that as a condition of my participation I agree to renounce any claim that I or any person acting in my name or stead would otherwise have the right to make against the Inspector, Quad City Ultralight Aircraft Corp., the National Ultralight group of incorporated entities, or any person or body associated with said companies, in any circumstances whatsoever in which I and/or my airplane and/or other property may be injured or damaged in any way including death and/or destruction.

I wish to participate notwithstanding and I have therefore signed this document which constitutes a full acknowledgement of my obligations and full release of any claims which might otherwise be made.