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pdfNPS Form 10-355A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
OFFEROR FINANCIAL STATEMENTS AND PROJECTIONS
SMALL LEASES
PROPOSAL PACKAGE
L-XXXX000-YY
Financial Statements
Complete the appropriate Financial Statements as described below:
The Service needs this information to verify there are enough funds available to be able to pay the required expenses to execute the
requirements of the Draft Lease and satisfy any other existing debt. If the Offeror’s total debts exceed current assets, provide a
narrative explaining how these debts will be paid.
Financial Statements include both an Income Statement and a Balance Sheet. An Income Statement lists all of your income and
expenses as of the last day of your most recent fiscal year. A Balance Sheet lists everything that you own and everything that you owe
as of a certain date.
If an Offeror is not yet formed, each Offeror-Guarantor should submit the appropriate Financial Statements as set forth below.
The Service requires all existing business entities to submit Business Financial Statements.
Provide, at a minimum, an audited or reviewed (i) Income Statement for the two most recent fiscal years and (ii) Balance Sheets (1) for
the most recent fiscal year and (2) as of the end of the most recent month prior to the submission of your proposal. Business Financial
Statements should reflect the entity’s business as a whole, including all operations both inside and outside of the Area.
If the entity does not have audited or reviewed Financial Statements, complete the Most Recent Fiscal Year Balance Sheet (Table 1),
the Most Recent Month Balance Sheet (Table 2), and the Historical Income Statement (Table 3) provided below.
The Service requires Sole Proprietors to submit Personal Financial Statements.
Complete the Personal Financial Statements (Table 4) below.
Notes to Offeror and/or Offeror-Guarantor:
In the event the Offeror is not yet in existence, submit financial statements for each Offeror-Guarantor. Submit Business Financial
Statements if the Offeror-Guarantor is a business entity. Submit Personal Financial Statements if the Offeror-Guarantor(s) is an
individual.
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Table 1: Business Financial Statement - Most Recent Fiscal Year Balance Sheet
For Fiscal Year Ending:
Business Financial Statement- Most Recent Fiscal Year Balance Sheet
1
Cash in Bank
$
2
Accounts Receivable
$
3
Inventory
$
4
Other Current Assets (Describe)
$
5
Total Current Assets (add lines 1-4)
$
6
Personal Property (Equipment) Items
$
7
Other Fixed Assets (Describe)
$
8
(LESS Accumulated Depreciation)
$
9
Total Fixed Assets (add lines 6-7, minus line 8)
$
10
Total Assets (add lines 5 & 9)
$
11
Accounts Payable
$
12
Bank Loans Outstanding
$
13
Loans due to Owners
$
14
Other Current Liabilities (Describe)
$
15
Total Current Liabilities (add lines 11-14)
16
Long-Term Liabilities (Describe)
$
17
Total Liabilities (add lines 15 and 16)
$
18
Total Net Worth (line 10 minus line 17)
$
Describe the information in lines 4, 7, 14 & 16 below:
Table 2: Business Financial Statement - Most Recent Month Balance Sheet
Page 2 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
For Month Ending:
Business Financial Statement- Most Recent Month Balance Sheet
1
Cash in Bank
$
2
Accounts Receivable
$
3
Inventory
$
4
Other Current Assets (Describe)
$
5
Total Current Assets (add lines 1-4)
$
6
Personal Property (Equipment) Items
$
7
Other Fixed Assets (Describe)
$
8
(LESS Accumulated Depreciation)
$
9
Total Fixed Assets (add lines 6-7, minus line 8)
$
10
Total Assets (add lines 5 & 9)
$
11
Accounts Payable
$
12
Bank Loans Outstanding
$
13
Loans due to Owners
$
14
Other Current Liabilities (Describe)
$
15
Total Current Liabilities (add lines 11-14)
16
Long-Term Liabilities (Describe)
$
17
Total Liabilities (add lines 15 and 16)
$
18
Total Net Worth (line 10 minus line 17)
$
Describe the information in lines 4, 7, 14 & 16 below:
Table 3: Business Financial Statement - Historical Income Statement
Page 3 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Historical Income Statement
Some lines may not be used, place "N/A" in these lines.
Include revenues and expenses related to the business as a whole,
including any operations both inside and outside of the park.
1
Revenues
1a Revenue Source 1
1b Revenue Source 2
1c Revenue Source 3
1d Revenue Source 4
2
Total Revenues (add lines 1a-1d)
3
Cost of Goods Sold
4
Total Cost of Goods Sold
5
Gross Profit (line 2 minus line 4)
6
Direct Expenses
6a Salaries and Wages
6b Payroll Taxes and Benefits
6c Operating Supplies
6d Car and Truck Expenses
6e Other Direct Expense 1
6f Other Direct Expense 2
7
Total Direct Expenses (add lines 6a-6f)
8
Undistributed Expenses
8a Administrative and General
8b Marketing (Advertising)
8c Utilities
8d Repair and Maintenance
8e Other Undistributed Expense 1
8f Other Undistributed Expense 2
9
Total Undistributed Expenses (add lines 8a-8f)
10
Fixed Expenses
10a Insurance
10b Rent to NPS (if applicable)
10c Other Fixed Expense 1
10d Other Fixed Expense 2
11
Total Fixed Expenses (add lines 10a – 10d)
Total direct, undistributed and fixed expenses (add lines 7, 9 and
12
11)
13
EBITDA* (Line 5 minus line 12)
14
Depreciation and Amortization
15
Interest
Net Income Before Income Taxes
16
(Line 13, minus lines 14 & 15)
*Earnings before Interest, Taxes, Depreciation and Amortization
Year 1
Year 2
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Page 4 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Table 4: Personal Financial Statement
Personal Financial Statement
Name:
As of Date:
% Ownership:
1
Cash in Bank
$
2
IRA and Other Retirement Accounts
$
3
Stocks & Bonds in Taxable Accounts
$
4
Real Estate
$
5
Accounts and Loans Receivable
$
6
Life Insurance (Cash Surrender Value Only)
$
7
Automobile (Present Value Only)
$
8
Other Personal Assets (Describe)
$
9
Total Assets (add lines 1-8)
$
10
Accounts Payable
$
11
Bank Loans Outstanding
$
12
Mortgage Loans Outstanding
$
13
Other Loans Outstanding (Describe)
$
14
Unpaid Tax Liability
$
15
Other Liabilities (Describe)
$
16
Total Liabilities (add lines 10-14)
$
17
Total Net Worth (subtract line 16 from line 9)
$
18
Salary
$
19
Investment Income
$
20
Other Income (Describe)
$
21
Total Income (add lines 18-20)
$
22
Endorsements or Guarantees
$
23
Other Contingent Liabilities (Describe)
$
Total Contingent Liabilities (add lines 22-23)
24
Describe the information in lines 8, 13, 15, 20 & 23 below:
$
Page 5 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Personal Property
Using Table 5 below, list all currently owned personal property with monetary value equal to or exceeding [Insert $ amount] that you will
use for your operations inside of the Park and provide an estimate of its current value. Do not include any personal property for your
operations outside of the Park.
Using Table 5 below, list all of the personal property with monetary value equal to or exceeding [Insert $ amount] that you will intend to
acquire to use for this.
Table 5: Personal Property to be used in the Draft Contract
Personal Property to be used in the Draft Contract
(Principal Selection Factor 4 - Subfactor 4(b))
Personal Property
Total Value of Currently Owned Personal Property
Personal Property
Value of Currently Owned
Personal Property
Quantity
Quantity
Total Value of Personal Property Investment
$
$
$
$
$
Value of Personal
Property that will be Acquired
Prior to Operation
$
$
$
$
$
Page 6 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Start-Up Costs
Estimate the start-up costs needed to begin operating the business (within the Park only) and use those estimates to complete the
Table 6 below. Only provide estimates for those items you need to acquire in order to begin operating. Do not include costs
for items you already own. For working capital (cash), estimate the amount of cash you will need to have available after purchasing
the other items (describe) in order to begin operating the business. For example, working capital would include salaries and rent you
will pay before you generate income from the operations in the Park.
The total “Value of Personal Property Investment that will be Acquired Prior to Operation” that you listed in the previous table should be
equal to the amount you list for Personal Property in this table.
Table 6: Start-Up Costs
Estimate of Investment Required to Begin Operations in the Draft Lease
Acquisition/Investment Category
Acquisition/Investment Amount
Personal Property (Equipment)
$
Merchandise (Inventory)
$
Supplies
$
Working Capital (Cash)
$
Other (Describe)
$
Total Funds Needed
Describe “Other” investment listed in the table:
$
Page 7 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Operating Projections
a)
Based on the condition of your personal property provided or purchased for the operation, attach a list of items using Table 7,
that you will need to replace during the term of the Draft Lease. Include the anticipated year for the expenditure, the quantity
of item(s) to be replaced, the description of the item(s), the approximate total value of the replacement, and how you plan to
pay for the personal property replacement. (For example, cash, bank loan etc.).
If your projected expenditures for personal property investments exceeds [Insert $ amount], provide an explanation of how you will fund
the investment.
If you will not need to replace personal property during the term of the Draft Lease, explain your reasoning.
Add or remove rows for years as needed in Table 7.
Table 7: Additional Personal Property Investments
Additional Personal Property Investments during the term of the Draft Lease
Anticipated Year
of Expenditure
Quantity
Capitalized Personal Property (Equipment) Items
Total Value
How will you fund
the investment?
Year 1
Year 1
Year 2
Year 2
Year 3
Year 3
Year 4
Year 4
Year 5
Year 5
Year 6
Year 6
Year 7
Year 7
Year 8
Year 8
Year 9
Year 9
Year 10
Year 11
b)
Demonstrate that your proposal is financially feasible carrying out the terms and conditions of the Draft Lease by
completing the following Prospective Income Statement, Table 8.
•
Estimate the amount of income and expenses for the proposed operation for the first year of operation. We included
blank lines on the prospective income statement for your estimates for expense categories we did not list. Describe
those categories on the blank lines.
Page 8 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
•
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Include only revenues and expenses related to the services authorized by the Draft Lease inside the Park. Do not
include other services you may provide outside the Park.
Fully explain the assumptions on which you base your projections and provide sufficient details so we fully understand
your assumptions. Provide revenue estimates by department, if applicable. If the projections show significantly increased
revenues from the projections provided in your response to the Request, provide a full explanation of the changes.
Note to Offeror: If you are not familiar with making these types of projections, you should consult an accountant or business
advisor.
Additional Instructions for completing the Prospective Income Statement on the next page:
Line 1:
Line 8a:
Line 10a:
Line 13:
If applicable, show revenues by departments (separate revenue activities - e.g., guide services, gift sales, snack bar
revenue, etc.).
Administrative and General includes the costs of managing the business and may include items such as: credit card
commissions; legal and accounting fees; travel; meals and entertainment; postage and printing; professional training;
telecommunications expenses; etc.
Insurance: As required in Exhibit [ ] of the Draft Lease
Earnings before Interest, Taxes, Depreciation and Amortization
Page 9 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
Table 8: Prospective Income Statement
Prospective Income Statement
1
2
3
4
5
6
7
8
If a line is marked with an asterisk, see additional notes on the previous page.
Some lines may not be used, place "N/A" in these lines.
Include only revenues and expenses related to the services required and authorized by the Draft
Lease inside the park in your prospective income statement. Do not include other services
you provide outside the park. This is unlike the Income Statement you provided in Subfactor 4(a).
Year 1
Assumptions
1a
1b
1c
1d
6a
6b
6c
6d
6e
6f
8a
8b
8c
8d
8e
8f
9
10
10a
10b
10c
10d
11
12
13
14
15
16
Revenues*
Revenue Source 1
Revenue Source 2
Revenue Source 3
Revenue Source 4
Total Revenues (add lines 1a-1d)
Cost of Sales
Total Cost of Sales
Gross Profit (Line 2 minus line 4)
Direct Expenses
Salaries and Wages
Payroll Taxes and Benefits
Operating Supplies
Car and Truck Expenses
Other Direct Expense 1
Other Direct Expense 2
Total Direct Expenses (add lines 6a-6f)
Undistributed Expenses
Administrative and General*
Marketing (Advertising)
Utilities
Repair and Maintenance
Other Undistributed Expense 1
Other Undistributed Expense 2
Total Undistributed Expenses (add lines 8a-8f)
Fixed Expenses
Insurance*
NPS Franchise Fee
Other Fixed Expense 1
Other Fixed Expense 2
Total Fixed Expenses (add lines 10a-10d)
Total direct, undistributed and fixed expenses (add lines 7, 9 and 11)
EBITDA* (Line 5 minus line 12)
Depreciation and Amortization
Interest
Net Income Before Income Taxes
(Line 13, minus lines 14 & 15)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Page 10 of 11
NPS Form 10-359A (Rev. 7/2020)
National Park Service
OMB Control No. 1024-0233
Expiration Date: XX/XX/XXXX
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 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, 1201 Oakridge Drive, Fort Collins, CO 80525. Please do not send your completed
form to this address.
Page 11 of 11
| File Type | application/pdf |
| Author | EChavis |
| File Modified | 2020-07-08 |
| File Created | 2020-07-08 |