Business History Information

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NPS Form 10-358 (Rev.12/2019)
National Park Service

BUSINESS HISTORY INFORMATION

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

PROPOSAL PACKAGE
CC-XXXX000-XX
Business History Information Form
(Principal Selection Factor 4 - Subfactor 4(a))
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 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

RECORDS RETENTION. TEMPORARY. Destroy/Delete 3 years after closure. (NPS Records Schedule, Commercial Visitor Services, (Item 5D)
(N1-79-08-4))

NPS Form 10-358 (Rev. 08/2016)
National Park Service

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

NOTICES
PRIVACY ACT STATEMENT
Authority: 16 U.S.C. 5966, Commercial Use Authorizations.
Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Commercial Services
program allowing 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 commercial uses within a unit of the National Park System; (3) to track applicants and holders
of commercial use authorizations 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 Commercial Use Authorizations (CUA) 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 CUA
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) Commercial Services Program allowing commercial uses within a unit of the NPS, 2) monitor
resources that are or may be affected by the authorized 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 Title IV of the National Parks Omnibus Management Act of 1998 (Pub. L.
105–391). We use this information to evaluate a concession proposal. Your response is required to obtain or retain a
benefit. 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. 1024-0029.
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 at [email protected] (email). Please do not send
your completed form to this address.