BOST_Building 125_RFP_Attachment B_Business-History-Forms.pdf

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RFP to Lease Building 125 in Charlestown Navy Yard at Boston National Historical Park
Solicitation number
BOST_Building-125_RFP
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About this file

This document is a National Park Service (NPS) proposal package containing three required forms for entities seeking to lease or conduct business within units of the National Park System.

NPS Form 10-352, the Business History Information Form, requires offerors and any entities providing financial or management assistance to disclose past contract defaults, terminations, bankruptcies, receiverships, foreclosures, pending litigation, financial obligation disputes, and recorded liens from the past five years. The form requests full details and supporting documentation for any affirmative responses. NPS Form 10-353 applies to individual offerors or sole proprietorships and requires disclosure of the individual's name, tradename if applicable, business address, contact information, Tax ID, years in business of the same type, current business value, and the entity's role in providing proposed services. NPS Form 10-354 applies to corporations, limited liability companies, partnerships, or joint ventures and requires disclosure of the entity name, formation state and date, Tax ID, contact information, ownership structure with names and addresses of controlling interests and key principals, percentage ownership interests, current investment values, and officers and directors. All three forms are part of the standardized proposal package (L-XXXX000-YY) used for NPS leasing program evaluations. The forms carry OMB Control No. 1024-0233 with an expiration date of May 31, 2029, and are authorized under 54 U.S. Code Chapter 1021. Estimated completion time ranges from one hour for Form 10-353 to five to ten hours for Form 10-354, depending on business complexity.

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NPS Form 10-352 (Rev. 5/2026) National Park Service

OMB Control No. 1024-0233 Expiration Date: 05/31/2029

BUSINESS HISTORY INFORMATION

PROPOSAL PACKAGE

L-XXXX000-YY

Business History Information Form

Business history information should be provided for the Offeror AND any entity that will provide financial or management assistance. If the Offeror is not yet formed, provide a business history form for each Offeror-Guarantor.

The information provided below is for the entity:

(1) Has Offeror ever defaulted from or been terminated from a lease, management or concession contract, or been forbidden from contracting by a public agency or private company?

YES NO

If YES, provide full details of the circumstances.

(2) List any Bankruptcies, Receiverships, Foreclosures, Transfers in Lieu of Foreclosure, and/or Work- Out/Loan Modification Transactions during the past five years. Include an explanation of the circumstances, including nature of the event, date, type of debt (e.g., secured or unsecured loan), type of security (if applicable), approximate amount of debt, name of lender, resolution, bankruptcy plan, and/or other documentation as appropriate. If none, check the box below. Otherwise, provide full details below.

NONE

(3) Describe any pending litigation or administrative proceeding (other than those covered adequately by insurance) which, if adversely resolved, could materially impact the financial position of the Offeror. If none, check the box below. Otherwise, provide full details below.

NONE

(4) Describe any lawsuit, administrative proceeding or bankruptcy case within the past five years that concerned the Offeror’s alleged inability or unwillingness to meet its financial obligations. If none, check the box below.

Otherwise, provide full details below.

NONE

(5) Describe any liens recorded against the Offeror within the past five years (whether from taxing authorities or judgments) and, if resolved, provide a copy of any lien release. If none, check the box below. Otherwise, provide full details below.

NONE

NPS Form 10-352 (Rev. 5/2026)

OMB Control No. 1024-0233 Expiration Date: 05/31/2026

NOTICES

PRIVACY ACT STATEMENT

Authority: 54 U.S. Code Chapter 1021—Privileges and Leases; 54 U.S. Code § 306121—Lease or exchange.

Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Leasing program allowing for residential and commercial uses within a unit of the National Park System to ensure that business activities are conducted in a manner that complies with Federal laws and regulations; (2) to monitor resources that are or may be affected by the authorized residential and/or commercial uses within a unit of the National Park System; (3) to track applicants and holders of leases who are planning to conduct or are conducting business within units of the National Park System; and (4) to provide to the public the description and contact information for businesses that provide services in national parks.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or information contained in this system may be disclosed outside DOI as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other Federal, state and local governments, tribal organizations, and members of the general public upon request for names, addresses and phone numbers of lease holders conducting business within units of the National Park System for the purpose of informing the public of the availability of the services offered by the lease holder. In addition, records or information contained in this system may be disclosed outside DOI based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.

Disclosure: Voluntary, however, failure to provide the requested information may impede our ability to 1) manage the National Park Service (NPS) Leasing Program allowing for residential and/or commercial uses within a unit of the NPS, 2) monitor resources that are or may be affected by the authorized residential and/or commercial uses, and 3) provide the public the description and contact information for businesses that provide services in national parks.

PAPERWORK REDUCTION ACT STATEMENT

We collect this information under the authority of 54 U.S.C. Chapter 1021. We use this information to evaluate a lease proposal. Your response is required to obtain or retain a benefit. We may not collect or sponsor and you are not required to respond a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1024-0233.

ESTIMATED BURDEN STATEMENT

We estimate that depending on the complexity of your business history, it will take between 1 and 5 hours to complete this form, including time to review instructions, gather and maintain data, and complete and review the form. You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 1201Oakridge Drive, Fort Collins, CO 80550. Please do not send your completed form to this address.

NPS Form 10-353 (Rev.5/2026)

OMB Control No. 1024-0233 Expiration Date: 05/31/2029

BUSINESS ORGANIZATION INFORMATION

Individual* or Sole Proprietorship

Note: Either a Form 10-353 or Form 10-354 is completed for each proposal, depending on the nature of ownership of the company.

Complete separate form for the submitting business entity and any and all parent entities.

* Due to difficulties determining authority to act and ownership, the Service will not accept a proposal from spouses jointly as a purported business entity. Either one individual must serve as the Offeror or the spouses must form a corporation, partnership, or limited liability company to serve as Offeror.

** If the sole proprietorship acts under a name other than that of its owner (i.e., does business as “company name”), also add the jurisdiction where the company’s trade name is registered, if any.

PROPOSAL PACKAGE

L-XXXX000-YY

NPS Form 10-353 (Rev.5/2026)

OMB Control No. 1024-0233 Expiration Date: 05/31/2029

NOTICES

PRIVACY ACT STATEMENT

Authority: 54 U.S. Code Chapter 1021—Privileges and Leases; 54 U.S. Code § 306121—Lease or exchange.

Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Leasing program allowing for residential and commercial uses within a unit of the National Park System to ensure that business activities are conducted in a manner that complies with Federal laws and regulations; (2) to monitor resources that are or may be affected by the authorized residential and/or commercial uses within a unit of the National Park System; (3) to track applicants and holders of leases who are planning to conduct or are conducting business within units of the National Park System; and (4) to provide to the public the description and contact information for businesses that provide services in national parks.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or information contained in this system may be disclosed outside DOI as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other Federal, state and local governments, tribal organizations, and members of the general public upon request for names, addresses and phone numbers of lease holders conducting business within units of the National Park System for the purpose of informing the public of the availability of the services offered by the lease holder. In addition, records or information contained in this system may be disclosed outside DOI based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.

Disclosure: Voluntary, however, failure to provide the requested information may impede our ability to 1) manage the National Park Service (NPS) Leasing Program allowing for residential and/or commercial uses within a unit of the NPS, 2) monitor resources that are or may be affected by the authorized residential and/or commercial uses, and 3) provide the public the description and contact information for businesses that provide services in national parks.

PAPERWORK REDUCTION ACT STATEMENT

We collect this information under the authority of 54 U.S.C. Chapter 1021. We use this information to evaluate a lease proposal. Your response is required to obtain or retain a benefit. We may not collect or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1024-0233.

ESTIMATED BURDEN STATEMENT

We estimate that it will take no more than 1 hour to complete this form, including time to review instructions, gather and maintain data, and complete and review the form. You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 1201 Oakridge Drive, Fort Collins, CO 80525. Please do not send your completed form to this address.

NPS Form 10-354 (Rev. 5/2026)

OMB Control No. 1024-0233 Expiration Date: 05/31/2029

BUSINESS ORGANIZATION INFORMATION

Corporation, Limited Liability Company, Partnership, or Joint Venture

Note: Either a Form 10-353 or Form 10-354 is completed for each proposal, depending on the nature of ownership of the company.

Complete separate form for the submitting business entity and any and all parent entities.

PROPOSAL PACKAGE

L-XXXX000-YY

NPS Form 10-354 (Rev.5 /2026)

OMB Control No. 1024-0233 Expiration Date: 05/31/2029

NPS Form 10-354 (Rev. 5/2026)

OMB Control No. 1024-0233 Expiration Date: 05/31/2029

NOTICES

PRIVACY ACT STATEMENT

Authority: 54 U.S. Code Chapter 1021—Privileges and Leases; 54 U.S. Code § 306121—Lease or exchange.

Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Leasing program allowing for residential and commercial uses within a unit of the National Park System to ensure that business activities are conducted in a manner that complies with Federal laws and regulations; (2) to monitor resources that are or may be affected by the authorized residential and/or commercial uses within a unit of the National Park System; (3) to track applicants and holders of leases who are planning to conduct or are conducting business within units of the National Park System; and (4) to provide to the public the description and contact information for businesses that provide services in national parks.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or information contained in this system may be disclosed outside DOI as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other Federal, state and local governments, tribal organizations, and members of the general public upon request for names, addresses and phone numbers of lease holders conducting business within units of the National Park System for the purpose of informing the public of the availability of the services offered by the leaseholder. In addition, records or information contained in this system may be disclosed outside DOI based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.

Disclosure: Voluntary, however, failure to provide the requested information may impede our ability to 1) manage the National Park Service (NPS) Leasing Program allowing for residential and/or commercial uses within a unit of the NPS, 2) monitor resources that are or may be affected by the authorized residential and/or commercial uses, and 3) provide the public the description and contact information for businesses that provide services in national parks.

PAPERWORK REDUCTION ACT STATEMENT

We collect this information under the authority of 54 U.S.C. Chapter 1021. We use this information to evaluate a lease proposal. Your response is required to obtain or retain a benefit. We may not collect or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1024-0233.

ESTIMATED BURDEN STATEMENT

We estimate that depending on the complexity of your business organization it will take between 5 and 10 hours to complete this form, including time to review instructions, gather and maintain data, and complete and review the form. You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 1201 Oakridge Drive, Fort Collins, CO 80525. Please do not send your completed form to this address.

BUSINESS HISTORY INFORMATION
NOTICES PRIVACY ACT STATEMENT
Authority: 54 U.S. Code Chapter 1021—Privileges and Leases; 54 U.S. Code § 306121—Lease or exchange.
PAPERWORK REDUCTION ACT STATEMENT
ESTIMATED BURDEN STATEMENT
Form-10-353-Business-Organization-Information-Individual-or-Sole-Proprietors_508_Compliant-2 (1).pdf
BUSINESS ORGANIZATION INFORMATION
PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
ESTIMATED BURDEN STATEMENT
Form-10-354-Business-Organization-Information-Corporation-Limited-Liability_508_Compliant-2.pdf
BUSINESS ORGANIZATION INFORMATION
NOTICES PRIVACY ACT STATEMENT
PAPERWORK REDUCTION ACT STATEMENT
ESTIMATED BURDEN STATEMENT
Business Name:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off
Individual and Tradename:
Email Address:
Years in Business:
Current Value of Business:
Role in Providing Proposed Service(s):
Entity and Tradename:
Address:
Telephone Number:
Fax Number:
Email address:
Contact Person:
Title:
Tax ID Number:
State of Formation:
Date of Formation:
Ownership1:
Percent of Ownership Interests1:
Current Value1:
Ownership2:
Percent of Ownership Interests2:
Current Value2:
Individual1:
Address1:
Title/Affiliation1:
Individual3:
Address3:
Title/Affiliation3:
Individual2:
Address2:
Title/Affiliation2:
Individual4:
Address4:
Title/Affiliation4:
Individual5:
Address5:
Title/Affiliation5:
Individual6:
Address6:
Title/Affiliation6:
Individual7:
Address7:
Title/Affiliation7:

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