Fill a Valid Ohio 3011 Form

The Ohio 3011 form is an application used by firms seeking a Certificate of Authorization to provide professional engineering and surveying services in Ohio. This form is essential for new applications, annual renewals, and any changes to services or firm names. Completing the Ohio 3011 accurately is crucial, as any errors or omissions can lead to delays or rejection of the application.

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OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

Certiicate of Authorization application instructions

3010

Each application must include…

•Notarized Certiicate of Authorization application: PES 3011 (Rev. 03/2011).

•Separate notarized Firm afidavit of responsibility for each professional engineer and professional surveyor designated in responsible charge: PES 3012 (Rev. 03/2011).

•An active Ohio Secretary of State charter or registration number authorizing the irm to do business in the state of Ohio. In addition, if a irm is using a doing business as (DBA) name, an active Ohio Secretary of State charter or registration number authorizing the irm’s DBA name to do business in the state of Ohio is needed.

•Appropriate application fee, using check or money order, and made payable in U.S. funds to treasurer, State of Ohio. NEW, ADDITIONAL SERVICE, or NAME CHANGE application fee is $50.00. ANNUAL RENEWAL application fee is $25.00. LATE ANNUAL RENEWAL application fee is $37.50.

Contacting Ohio’s Secretary of State

Contact information for the Ohio Secretary of State’s ofice is provided as a courtesy and may be subject to change.

•On the web www.sos.state.oh.us

•Telephone (877) 767-6446 U.S. toll free or (614) 466-2655 Columbus metro

important checklist information

•Application must be illed out completely. All ields are required unless otherwide indicated.

•Each full-time employee designated in responsible for, and responsible charge of, the professional engineering or pro- fessional surveying activities and decisions must ill out Firm afidavit of responsibility PES 3012 (Rev. 03/2011).

•The full-time employee must be a partner, manager, member, oficer or director and shall be registered in this state. Full- time, as deined in Ohio R.C. section 4733.16, means working more than 30 hours per week or working substantially all the engineering and/or surveying hours for a irm that holds a Certiicate of Authorization.

•The irm and/or its DBA must hold an active registration(s) with the Ohio Secretary of State.

•Applications without the correct fee or with incomplete information will be returned.

•All Certiicates of Authorization expire annually on June 30.

•Failure to renew the Certiicate of Authorization by the June 30 deadline renders the irm inactive and unauthorized to practice in the state of Ohio.

•Firms must notify the Board within 30 days of any change of the irm’s name or address.

•Firms are responsible for notifying the Board within 30 days of any changes of partners, managers, oficers, members, directors, shareholders, designated professional engineers, designated professional surveyors or change of ownership.

•Firms with a name change must ile a new application and include an application fee of $50.00.

•Firms adding an additional service must ile a new application and include an application fee of $50.00.

•Firms that do not wish to renew their Certiicate of Authorization must notify the Board in writing.

•A Certiicate of Authorization is not the same as an individual license to practice professional engineering or professional surveying in the state of Ohio.

Disclosure statement, privacy notice

Ohio’s State Board of Registration for Professional Engineers and Surveyors is requesting disclosure of information that is necessary to accomplish our statutory purposes required by Ohio Revised Code Chapter 4733. Failure to provide required information may result in your approval being delayed or your application being returned. Subject to certain Ohio Revised Code statutory exceptions, most documents and records maintained by the state of Ohio, including those maintained by the Board, are public records under Ohio law. This means that information submitted to us from you may be subject to disclosure if there is an oficial public records request.

Deliver completed Certiicate of Authorization application with afidavit(s) and fee to:

CERTIFICATE OF AUTHORIZATION

OHIO ENGINEERS AND SURVEYORS BOARD 50 W BROAD ST STE 1820

COLUMBUS OH 43215-5905

Questions?

pes.board@pes.ohio.gov

FAX

(614) 728-3059

U.S. tOLL FrEE

(877) 644-6364

PES 3010 (Rev. 03/2011) 20110301

Page 1 of 1

OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

Certiicate of Authorization application

3011

This application is for irms requiring a Certiicate of Authorization in order to provide, or offer to provide, professional engineering and/or professional surveying services in Ohio. Use this application for new, annual renewal and late annual renewal approvals; or for adding an additional service or a name change. All ields required unless otherwise indicated. The appropriate nonrefundable application fee must be included using check or money order and made payable in U.S. funds to treasurer, State of Ohio. An incomplete application — or an application without the appropriate fee — cannot be processed and will be returned.

Application for >> CHOOSE ONLY ONE
$50.00 NEW			$25.00 ANNUAL rENEWAL
$50.00 ADDitiONAL SErviCE			$37.50 LAtE ANNUAL rENEWAL
$50.00 NAME CHANGE

ENTER PREVIOUS FIRM NAME >>

Ohio Certiicate of Authorization number >> rEQUirED unless new irm

Professional services to be offered by irm

Engineering ONLY

Surveying ONLY

Engineering AND Surveying

Firm is registered with the Ohio Secretary of State as

Corporation	LLC	Partnership	Professional Association

Other DESCRIBE FIRM TYPE >>

Firm contact information >> ALL FiELDS rEQUirED UNLESS OTHERWISE INDICATED

An active Ohio Secretary of State (SOS) charter or registration number authorizing the irm to do business in the state of Ohio is required for each irm name and irm DBA name, if used. Contact the Secretary of State at www.sos.state.oh.us.

OHIO SOS NO.	FIRM NAME

OHIO SOS NO. >> rEQUirED with DBA FIRM DBA >> ONLY if using DBA (Doing Business As) name

CONTACT EMAIL ADDRESS		FEDERAL EMPLOYER ID NUMBER

LOCAtiON OFFEriNG OHiO PrOFESSiONAL SErviCES

ADDRESS LINE 1 >> DO NOt USE AGENt ADDrESS — PO Box is NOt acceptable

Indicate if change of address

TELEPHONE

ADDRESS LINE 2 >> ONLY if needed

CITY

COUNTY >> ONLY if Ohio address

STATE ZIP+4

MAiLiNG ADDrESS >> ONLY IF DIFFERENT THAN ABOVE LOCATION		Indicate if change of address
ADDRESS LINE 1	>> DO NOt USE AGENt ADDrESS		TELEPHONE

ADDRESS LINE 2	>> ONLY if needed		COUNTY >> ONLY if Ohio address

CITY			STATE ZIP+4

PES 3011 (Rev. 03/2011)

Page 1 of 4

OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

Certiicate of Authorization application

3011

Ownership If irm has more than four owners, attach additional pages with the same information.

1 FIRM OWNER NAME		FIRM OWNER ADDRESS

2 FIRM OWNER NAME

3 FIRM OWNER NAME

4 FIRM OWNER NAME

FIRM OWNER ADDRESS

registered individuals in responsible charge All professional services shall be executed by, or be under the direct supervision of, an Ohio-registered professional engineer or professional surveyor. Pursuant to Ohio R.C. section 4733.16, each corporation, limited liability company, partnership or professional association through which professional engineering or surveying services are offered or provided in Ohio, shall designate one or more directors, partners, managers, members or oficers employed by the irm full time as being responsible for and in responsible charge of the professional engineering or professional surveying activities and decisions of the irm.

Name, registration number, position of registrant in responsible charge iMPOrtANt! Each registrant

listed as in responsible charge must include an accompanying Firm Afidavit of responsibility (PES 3012). If more than four registrants are in responsible charge, attach additional pages with the same information.

1 PRINTED NAME >> include notarized PES 3012iNDiCAtE ALL tHAt APPLY

		Director	Partner	Manager
		Member	Oficer
OHIO P.E. NUMBER	OHIO P.S. NUMBER	Member	Oficer


2 PRINTED NAME >> include notarized PES 3012		iNDiCAtE ALL tHAt APPLY
		Director	Partner	Manager
		Member	Oficer
OHIO P.E. NUMBER	OHIO P.S. NUMBER	Member	Oficer


3 PRINTED NAME >> include notarized PES 3012		iNDiCAtE ALL tHAt APPLY
		Director	Partner	Manager
		Member	Oficer
OHIO P.E. NUMBER	OHIO P.S. NUMBER	Member	Oficer


4 PRINTED NAME >> include notarized PES 3012		iNDiCAtE ALL tHAt APPLY
		Director	Partner	Manager
		Member	Oficer
OHIO P.E. NUMBER	OHIO P.S. NUMBER	Member	Oficer

PES 3011 (Rev. 03/2011)

Page 2 of 4

OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

Certiicate of Authorization application

3011

Additional Ohio P.E., P.S. registrants employed by irm

List registrant name, registration number and irm location address of each Ohio P.E. or Ohio P.S. whose services are employed by the irm as of the date of this application. If needed, attach additional pages with the same information required below.

1 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER


2 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER


3 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER


4 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER


5 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER


6 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER


7 REGISTRANT NAME		FIRM LOCATION ADDRESS

OHIO P.E. NUMBER	OHIO P.S. NUMBER

Disclosure statement, privacy notice

Ohio’s State Board of Registration for Professional Engineers and Surveyors is requesting disclosure of information that is necessary to accomplish our statutory purpose required by Ohio R.C. Chapter 4733. Failure to provide required information may result in your application approval being delayed or your application being returned.

Subject to certain Ohio Revised Code statutory exceptions, most documents and records maintained by the state of Ohio, including those maintained by the Board, are public records under Ohio law. This means that information submitted to us from you may be subject to disclosure if there is an oficial public records request.

PES 3011 (Rev. 03/2011)

Page 3 of 4

OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

Certiicate of Authorization application

3011

Notarized afidavit

STATE OF

AFFiANt

I,[ PRINTED NAME ] ,

being duly sworn, or afirmed, depose and say that I am duly authorized to prepare this application for a Certiicate of Authorization and attest, to the best of my knowledge and belief, that the information contained herein is true.

DECLArAtiON in accordance with section 2909.32 (A)(2)(b) of the Ohio revised Code

For each question, indicate either “yes” or “no” in the space provided. Responses must be truthful to the best of your knowledge.

		YES	NO
1. Are you a member of an organization on the U.S. Department of State Terrorist Exclusion List?
2.	Have you used any position of prominence you have with any country to persuade others to support an organization	YES	NO
	on the U.S. Department of State Terrorist Exclusion List?
3.	Have you knowingly solicited funds or other things of value for an organization on the U.S. Department of State	YES	NO
	Terrorist Exclusion List?
4.	Have you solicited any individual for membership in an organization on the U.S. Department of State Terrorist	YES	NO
	Exclusion List?

5.Have you committed an act that you know, or reasonably should have known, affords “material support or resources” to an organization on the U.S. Department of State Terrorist Exclusion List? .......................................

6.Have you hired or compensated a person you knew to be a member of an organization on the U.S. Department of State Terrorist Exclusion List, or a person you knew to be engaged in planning, assisting, or carrying out an act of terrorism?....................................................................................................................................................

YES NO

AFFIANT SIGNATURE

AFFIANT TITLE

DATE SIGNED

NOtArY

Subscribed and sworn, or afirmed, to me this

	day of	,	.
	day of	,	.
Witness my hand and seal hereon.
NOTARY SIGNATURE				MY COMMISSION EXPIRES

	L
	A
S	E
S
Y
R

N	O
	O
	T
	A
	R
		Y
	E	S
	E
L	A
L

Deliver completed Certiicate of Authorization application with afidavit(s) and fee to:

CERTIFICATE OF AUTHORIZATION

OHIO ENGINEERS AND SURVEYORS BOARD 50 W BROAD ST STE 1820

COLUMBUS OH 43215-5905

Questions?

pes.board@pes.ohio.gov

FAX

(614) 728-3059

U.S. tOLL FrEE

(877) 644-6364

PES 3011 (Rev. 03/2011)

Page 4 of 4

OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

Firm afidavit of responsibility

3012

Complete a separate Firm afidavit of responsibility for each professional engineer or professional surveyor who is designated in responsible charge. Afidavits of responsibility must accompany all Certiicate of Authorization applications.

Firm name, Ohio Board Certiicate of Authorization number

FIRM NAME >> SAME NAME as on Certiicate of Authorization application OHIO BOARD CERTIFICATE OF AUTHORIZATION NUMBER >> 5-DiGitS

Professional services to be offered by irm

Engineering ONLY

Surveying ONLY

Engineering AND Surveying

Ohio registrant designated in responsible charge

OHIO P.E., P.S. OR DUAL (P.E. AND P.S.) REGISTRANT DESIGNATED IN RESPONSIBLE CHARGE		P.E. NUMBER		P.S. NUMBER

Notarized afidavit

STATE OF

AFFiANt

I,[ AFFIANT PRINTED NAME ] ,

being the duly sworn, or afirmed, afiant; state that I am a registered professional engineer and/or a registered professional surveyor in the state of Ohio as indicated above; that I am a full time employee of the above-named irm; that I am in responsible charge for and in responsible charge of the professional engineering or professional surveying activities and decisions of this irm; and that I meet the requirements pursuant to Ohio Revised Code Chapter 4733 for such designation.

AFFIANT SIGNATURE

DATE SIGNED

NOtArY

Subscribed and sworn, or afirmed, to me this

	day of	,	.
	day of	,	.
Witness my hand and seal hereon.
NOTARY SIGNATURE				MY COMMISSION EXPIRES

	L
	A
S	E
S
Y
R

N	O
	O
	T
	A
	R
		Y
	E	S
	E
L	A
L

Deliver completed Certiicate of Authorization application with afidavit(s) and fee to:

CERTIFICATE OF AUTHORIZATION

OHIO ENGINEERS AND SURVEYORS BOARD 50 W BROAD ST STE 1820

COLUMBUS OH 43215-5905

Questions?

pes.board@pes.ohio.gov

FAX

(614) 728-3059

U.S. tOLL FrEE

(877) 644-6364

PES 3012 (Rev. 03/2011) 20110301

Page 1 of 1

Document Properties

Fact Name	Description
Application Requirement	The PES 3011 form must be completed and notarized to apply for a Certificate of Authorization in Ohio.
Governing Law	This form is governed by Ohio Revised Code Chapter 4733, which outlines the registration of professional engineers and surveyors.
Fees	The application fees vary: $50 for new applications, $25 for annual renewals, and $37.50 for late renewals.
Expiration	Certificates of Authorization expire annually on June 30. Failure to renew by this date will render the firm inactive.
Notification of Changes	Firms must inform the Board within 30 days of any changes in ownership, address, or designated professionals.

Documents used along the form

The Ohio 3011 form is essential for firms seeking a Certificate of Authorization to provide professional engineering and surveying services in Ohio. Along with this form, several other documents are commonly required to ensure compliance with state regulations. Below is a list of these forms and documents, each serving a specific purpose in the application process.

PES 3010: This is the application instructions form that outlines the requirements for submitting the Certificate of Authorization application. It provides essential details on what documents are needed and how to complete the application correctly.
PES 3012: This is the Firm Affidavit of Responsibility. Each professional engineer or surveyor designated in responsible charge must complete this notarized affidavit, confirming their role and responsibilities within the firm.
Ohio Secretary of State Registration: Firms must provide proof of an active charter or registration number from the Ohio Secretary of State. This ensures that the firm is legally authorized to conduct business in Ohio.
Application Fee Payment: A check or money order must accompany the application, payable to the Treasurer, State of Ohio. The fee varies based on the type of application, such as new, renewal, or name change.
Disclosure Statement: This document requests information necessary for the Board to fulfill its statutory purposes. It informs applicants that their information may be subject to public records requests.
Notarized Affidavit: This affidavit must be signed by an authorized individual who attests to the truthfulness of the information provided in the application. It serves as a legal declaration of the firm's compliance.
Change of Address Notification: If there are any changes to the firm's address or ownership, the Board must be notified within 30 days. This document ensures that all information remains current and accurate.
California Motorcycle Bill of Sale: This form is essential for transferring ownership of a motorcycle in California. It includes key information such as the VIN, sale price, and details of both buyer and seller, ensuring protection during the transaction. For more information, you can visit documentonline.org/blank-california-motorcycle-bill-of-sale/.
Additional Service or Name Change Application: If a firm wishes to add services or change its name, a separate application and fee are required. This helps maintain accurate records of the firm's offerings and identity.

Understanding these forms and documents is crucial for a smooth application process. Each plays a significant role in ensuring that firms meet the necessary legal requirements to operate in Ohio. Proper preparation can save time and avoid delays in obtaining the Certificate of Authorization.

Guidelines on Filling in Ohio 3011

Filling out the Ohio 3011 form is an important step for firms seeking a Certificate of Authorization to provide professional engineering and surveying services in Ohio. It's essential to ensure that all information is accurate and complete to avoid delays or rejections. Here’s how to properly fill out the form.

Obtain the Ohio 3011 form from the Ohio State Board of Registration for Professional Engineers and Surveyors website.
Fill out the application type by selecting one option: NEW, ANNUAL RENEWAL, ADDITIONAL SERVICE, LATE ANNUAL RENEWAL, or NAME CHANGE.
Provide the previous firm name if applicable and enter the Ohio Certificate of Authorization number if it exists.
Indicate the professional services the firm will offer: Engineering ONLY, Surveying ONLY, or Engineering AND Surveying.
Specify the firm’s registration type with the Ohio Secretary of State (e.g., Corporation, LLC, Partnership, etc.) and provide the firm’s Ohio Secretary of State number.
If using a DBA (Doing Business As) name, include the DBA name and its Ohio Secretary of State number.
Fill in the firm contact information, including the physical address (do not use a PO Box), telephone number, and email address.
Complete the ownership section by listing the names and addresses of all firm owners (if more than four, attach additional pages).
Designate registered individuals in responsible charge by providing their names, registration numbers, and positions. Each must include a notarized Firm Affidavit of Responsibility (PES 3012).
List additional Ohio P.E. or P.S. registrants employed by the firm, including their names, registration numbers, and firm location addresses.
Complete the notarized affidavit section, ensuring the affiant’s name, title, and signature are included. Responses to the declaration questions must be truthful.
Include the appropriate application fee, payable by check or money order to the Treasurer, State of Ohio. Ensure the fee matches the application type selected.
Review the application for completeness and accuracy. Ensure all required fields are filled out.
Submit the completed application, affidavits, and fee to the Ohio Engineers and Surveyors Board at the specified address.

After submitting your application, it will be processed by the Ohio Engineers and Surveyors Board. If everything is in order, you will receive your Certificate of Authorization. If there are any issues, you may be contacted for clarification or additional information. It's crucial to keep track of renewal dates to maintain your firm's active status in Ohio.

Common mistakes

Completing the Ohio 3011 form can be a straightforward process, but there are common mistakes that applicants often make. One frequent error is failing to complete all required fields. The application explicitly states that all fields are mandatory unless indicated otherwise. Incomplete applications will be returned, which can delay the approval process.

Another common mistake is neglecting to include the appropriate fee. The application requires a nonrefundable fee, which varies depending on the type of application. Applicants must ensure that they submit the correct amount, as applications without the correct fee will also be returned. It is essential to double-check the fee structure before submitting the form.

Many applicants mistakenly assume that their firm’s name is sufficient for identification. However, it is crucial to provide the Ohio Secretary of State (SOS) registration number for both the firm and any Doing Business As (DBA) names. Failing to include this information can lead to complications and delays in processing the application.

Another oversight involves the notarization of documents. Each application must include a notarized Certificate of Authorization application and a separate notarized Firm affidavit of responsibility for each professional engineer and surveyor designated in responsible charge. Omitting the notarization can result in the application being deemed incomplete.

Additionally, some applicants overlook the requirement to notify the Board of any changes within 30 days. This includes changes to the firm’s name, address, or ownership structure. Not adhering to this requirement can lead to the firm being rendered inactive and unauthorized to practice in Ohio.

Finally, applicants often confuse the Certificate of Authorization with an individual license. It is important to understand that the Certificate does not equate to a personal license to practice engineering or surveying in Ohio. This misunderstanding can lead to compliance issues and potential legal ramifications.

FAQ

What is the Ohio 3011 form?

The Ohio 3011 form is an application for a Certificate of Authorization, which is required for firms that wish to provide or offer professional engineering and/or professional surveying services in the state of Ohio. This form can be used for new applications, annual renewals, late renewals, and for adding additional services or changing the firm's name.
What documents must accompany the Ohio 3011 form?

When submitting the Ohio 3011 form, several key documents are required:
- A notarized Certificate of Authorization application (PES 3011).
- A separate notarized Firm Affidavit of Responsibility (PES 3012) for each professional engineer and surveyor designated in responsible charge.
- An active Ohio Secretary of State charter or registration number for the firm, and if applicable, for any DBA name.
- The appropriate application fee, which varies depending on the type of application.
What are the application fees associated with the Ohio 3011 form?

The fees for the Ohio 3011 application are as follows:
- $50.00 for a new application or for adding an additional service.
- $25.00 for annual renewal.
- $37.50 for late annual renewal.
- $50.00 for a name change.
It’s important to note that these fees are nonrefundable and must be paid in U.S. funds.
What happens if the application is incomplete or submitted without the correct fee?

If the Ohio 3011 application is incomplete or lacks the appropriate fee, it will be returned to the applicant. To avoid delays, ensure that all fields are filled out completely and that the correct payment is included with your submission.
What are the renewal requirements for the Certificate of Authorization?

All Certificates of Authorization expire annually on June 30. To maintain an active status, firms must renew their authorization by this deadline. If a firm fails to renew by June 30, it becomes inactive and is unauthorized to practice in Ohio. Furthermore, firms are responsible for notifying the Board of any changes in ownership, address, or other significant changes within 30 days.