Form 10-352 Business History Information (SIMPLE)

NPS Form 10-352 (Rev.7/2020)
National Park Service

[SIMPLE]

OMB Control No. 1024-0233
Expiration Date: ##/##/####

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 WorkOut/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

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NPS Form 10-352 (Rev. 7/2020)
National Park Service

OMB Control No. 1024-0029
Expiration Date: ##/##/####

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 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, 1201 Oakridge Drive, Fort Collins, CO 80550. Please do not send your completed
form to this address.

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