Form 10-355 Financial Information for Revenue Producing Uses.docx
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| NPS Form 10-355 (Rev. 07/2020) | OMB Control No. 1024-0233 | |
| National Park Service | Expiration Date 10/31/2024 | |
| FINANCIAL INFORMATION FOR REVENUE-PRODUCING USES |
| NPS Leasing Program |
| Commercial Services Division |
| 1849 C Street, NW |
| Washington, DC 20240 |
| NPS Form 10-355 (Rev. 07/2020) | OMB Control No. 1024-#### |
| National Park Service | Expiration Date 10/31/2021 |
I. START UP COSTS
| Working Capital |
| Utility Hookups |
| Improvements |
| FF&E |
| Marketing |
| Legal |
Total Start Up Costs
Explain the basis of all estimates. The estimates must credibly demonstrate your understanding of the start-up costs associated with this lease opportunity.
II. Stabilized Operating Proforma
| Revenue |
| Expenses |
| General/Administrative |
| Operations |
| Building Maintenance |
| Grounds Upkeep |
| HVAC |
| Utilities |
Security
Other Expenses:
| Total Expenses |
| Net Income After Expenses |
| Annual Cost of Debt and Equity |
| Rent to NPS |
Net Cash Flow
Explain the basis of all estimates. These estimates must credibly demonstrate that your net revenue will be sufficient to permit payment of the proposed rent and otherwise demonstrate that your proposal is financially viable.
NOTICES
PRIVACY ACT STATEMENT
Authority: Title 54, National Park Service and Related Programs; and the National Environmental Policy Act of 1969.
Purpose: The purpose of the system is to assist, monitor, track and issue leases to individuals and businesses for National Park Service structures and land for activities that are not subject to authorization through a concession contract, commercial use authorization, or similar instrument in federally owned or administered property located within the boundaries of park areas. A leased property must be used for an activity and in a manner that is consistent with the purposes established by law for the park and be compatible with the programs of the National Park Service.
Routine Uses: Records or information contained in this system is not disclosed outside of the Department of the Interior except for those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act; or other authorized routine use when the disclosure is compatible with the purpose for which the records were compiled.
Disclosure: Voluntary, however, failure to provide the requested information may impede our ability to issue a lease contract to the individual or organization.
PAPERWORK REDUCTION ACT STATEMENT
We collect this information under the authority of 54 U.S.C. 102101 et seq., 54 U.S.C. 306121, and 36 CFR part 18. We use this information to evaluate proposals received in response to leasing opportunities. 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 you 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, 12201 Sunrise Valley Drive, Mail Stop 242, Reston, VA 20192. Please do not send your completed form to this address.
RECORDS RETENTION: TEMPORARY. Destroy/delete 3 years after closure. (NPS Records Schedule, Resource Management and Page 1 of 2 Lands (Item 1D) (N1-79-08-1)) image1.jpeg image2.jpg
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