10-355 Form 10-355 Financial Information for Revenue Producing

National Park Service Leasing Program -- 36 CFR 18

Form 10-355 Financial Information for Revenue Producing Uses

Requests for Qualifications/Requests for Proposals/Requests for Bids - Simple (Individual)

OMB: 1024-0233

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NPS Form 10-355 (Rev. 04/2017) OMB Control No. 1024-0233

National Park Service Expiration Date ##/##/####

FINANCIAL INFORMATION FOR REVENUE-PRODUCING USES


NPS Leasing Program

Commercial Services Division

1849 C Street, NW

Washington, DC 20240



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




Paperwork Reduction Act Statement


Paperwork Reduction Act Statement. We collect this information under the authority of Title IV of the National Parks Omnibus Management Act of 1998 (Pub. L. 105-391). We use this information to evaluate proposals received in response to leasing opportunities. Your response is required to obtain or retain a benefit. We estimate that it will take you 1 hour to complete this form. This estimate includes time for reviewing instructions, gathering and maintaining data, and completing and reviewing 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, 1849 C Street, NW, (2601), Washington, DC 20240. 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.


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 3

Lands (Item 1D) (N1-79-08-1))

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