Form 10-357A Business Organization Information (Corporation, Limited

NPS Form 10-357A (Rev.12 /2019)
National Park Service

BUSINESS ORGANIZATION INFORMATION
Corporation, Limited Liability Company, Partnership, or Joint Venture
(Principal Selection Factor 3)

OMB Control No. 1024-0029
Expiration Date: XX/XX/XXXX

Note: Either a Form 10-357A or Form 10-357B is completed for each proposal, depending on the nature of ownership of the company.
Complete separate form for the submitting business entity and any and all parent entities.
Name of Entity and Trade-name, if any
Address
Telephone Number

Fax Number

Email Address

Contact Person
Title
Tax ID#

Ownership
Names and Addresses of those with
controlling interest and key principals of
business

State of Formation

Percentage of Ownership Interests

Date of Formation

Current Value of Investment

Total Interests Outstanding and Type(s):

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

Page 1

NPS Form 10-357A (Rev. 12/2019)
National Park Service

Officers and Directors or General Partners
or Managing Members or Venturers

OMB Control No. 1024-0029
Expiration Date: XX/XX/XXXX

Address

Title and/or Affiliation

Attach the following:
•

Description of relationship of any Offeror-Guarantor to the Offeror with respect to funding and management.

Page 2

NPS Form 10-357A (Rev. 12/2019)
National Park Service

OMB Control No. 1024-0029
Expiration Date: XX/XX/XXXX

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. 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 NPS_ICR@nps.gov (email). Please do not send your completed form to this
address.

Page 3