<div class="chunk-title">Exhibit A</div>
<div class="chunk-content">
            <p class="b0">
               <span class="bold">Accident Reporting Form</span>
               <br>
               <span class="bold">Wayne Executive Jetport</span>
               </p>
            <p class="b0">
               In accordance with the accident reporting provisions of the Rules and Regulations
               governing the operation of the Wayne Executive Jetport, it is mandatory to report
               any damage to public property and any injury requiring medical attention. Damage to
               privately owned property located within the confines of the Airport is to be reported
               to the owner. The Airport Manager will help you with contacting the owner.
               </p>
            <p class="b0">
               This form is for local Airport usage and does not replace the reporting requirements
               of NTSB-830 with regard to aircraft accidents and incidents. A copy of a Federal accident
               report should be submitted in lieu of this form.
               </p>
            <p class="b0">
               1. Name of person
                _____
               <p class="b1"> _____
                  Age___________
                  </p>
               
            <p class="b0">
               Address
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Phone (H)____________________ (W)______________________
               </p>
            <p class="b0">
               Date and time of occurrence_____________________________________
               </p>
            <p class="b0">
               2. Nature and extent of injuries
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Description of accident/injury
                _____
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Name of doctor or hospital
                _____</p>
            <p class="b0">
               3. Kind of property and extent of damage (use reverse for vehicles and aircraft)
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Name of owner
                _____</p>
            <p class="b0">
               Address
                _____
               <p class="b2"> _____</p>
               
            <p class="b0">
               Phone (H)___________________(W)____________________
               </p>
            <p class="b0">
               4. Reported to Law Enforcement
                _____</p>
            <p class="b0">
               Report number
                _____</p>
            <p class="b0">
               Name of police department
                _____</p>
            <p class="b0">
               Weather condition(s)
                _____</p>
            <p class="b0">
               5. Vehicle/Aircraft identification (number 1)
               </p>
            <p class="b0">
               Name of owner
                _____</p>
            <p class="b0">
               Address
                _____
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Phone (H)________________________(W)______________________
               </p>
            <p class="b0">
               N Number (or TAG &amp; state)
                _____</p>
            <p class="b0">
               Year &amp; Make
               </p>
            <p class="b0">
               Modelâ€ƒ
                _____</p>
            <p class="b0">
               Serial number
               </p>
            <p class="b0">
               (VIN)
                _____</p>
            <p class="b0">
               6. Vehicle/Aircraft identification (number 2)
               </p>
            <p class="b0">
               Name of owner
                _____</p>
            <p class="b0">
               Address
                _____
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Phone (H)____________________(W)____________________
               </p>
            <p class="b0">
               N Number (or TAG &amp; state)
                _____</p>
            <p class="b0">
               Year &amp; Make
               </p>
            <p class="b0">
               Model
                _____</p>
            <p class="b0">
               Serial number
               </p>
            <p class="b0">
               (VIN)
                _____</p>
            <p class="b0">
               7. Name of Witness
                _____</p>
            <p class="b0">
               Address
                _____
               _________________________________________________________
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Phone (H)___________________(W)_______________________
               </p>
            <p class="b0">
               8. Name of Witness
                _____</p>
            <p class="b0">
               Address
                _____
               _________________________________________________________
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               Phone (H)___________________(W)_______________________
               </p>
            <p class="b0">
               9. Remarks or additional information
                _____
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
               <p class="b2"> _____</p>
               
            <p class="b0">
               10. Signature____________________ Date_____________
               </p></div>