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

3010

Certiicate of Authorization application instructions

 

Each application must include…

Notarized Certiicate of Authorization application: PES 3011.

Separate notarized Company afidavit of responsibility for each professional engineer and professional surveyor

designated in responsible charge: PES 3012.

An active Ohio Secretary of State charter or registration number authorizing the company to do business in the state of Ohio. In addition, if a company is using a doing business as (DBA) name, an active Ohio Secretary of State charter or registration number authorizing the company’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, NAME CHANGE, or ADDING DBA 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 otherwise indicated.

Each full-time employee designated in responsible for, and responsible charge of, the professional engineering or professional surveying activities and decisions must ill out Company afidavit of responsibility PES 3012.

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 company that holds a Certiicate of Authorization.

The company 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 company inactive and unauthorized

to practice in the state of Ohio.

Companies must notify the Board within 30 days of any change of the company’s name or address.

Companies 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.

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

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

Companies 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 your completed Certiicate of Authorization application with afidavit(s) and fee to the Board’s address below.

CErTifiCATE Of AUTHOrizATiON

STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS 50 W BROAD ST STE 1820

COLUMBUS OH 43215-5905

Questions?

EMAil

pes.board@pes.ohio.gov

fAX

(614) 728-3059

U.S. TOll frEE

(877) 644-6364

PES 3010 (Rev. 03/2012) 20120307 Page 1 of 1

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

3011

Certiicate of Authorization application

 

This application is for companies 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.

Application for >> CHOOSE ONLY ONE

$25.00 ANNUAl rENEWAl

$50.00 NEW

$50.00 AddiTiONAl SErviCE

$37.50 lATE ANNUAl rENEWAl

$50.00 NAME CHANgE or AddiNg dBA (doing Business As)

ENTER PREVIOUS COMPANY NAME >>

Ohio Certiicate of Authorization number >> rEQUirEd unless new company professional services to be offered by company

Engineering ONlY

Surveying ONlY

Engineering AND Surveying

Company is registered with the Ohio Secretary of State as

Corporation

LLC

Partnership

 

Professional Association

Other DESCRIBE COMPANY TYPE >>

Company contact information >> All fiEldS rEQUirEd UNLESS OTHERWISE INDICATED

An active Ohio Secretary of State (SOS) charter or registration number authorizing the company to do business in the state of Ohio is required for each company name and company DBA name, if used.

OHIO SOS NO.

COMPANY NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OHIO SOS NO. >> rEQUirEd with dBA COMPANY DBA >> ONlY if using dBA (doing Business As) name

 

 

 

 

 

 

 

 

 

 

 

CONTACT EMAIL ADDRESS

 

 

 

FEDERAL EMPLOYER ID NUMBER

 

 

 

 

 

 

 

 

 

 

 

lOCATiON OffEriNg OHiO prOfESSiONAl SErviCES

Indicate if change of address

ADDRESS LINE 1 >> dO NOT USE AgENT AddrESS — pO Box is NOT acceptable

 

 

TELEPHONE

 

 

 

 

 

 

 

 

 

 

 

ADDRESS LINE 2 >> ONlY if needed

 

 

 

COUNTY >> ONlY if Ohio address

 

 

 

 

 

 

CITY

 

 

 

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. 03/2012) 20120307

Page 1 of 4

Ownership If company has more than ive owners, attach additional pages with the same information.

1 COMPANY OWNER NAME

 

COMPANY OWNER ADDRESS

 

 

 

 

 

 

 

 

 

2 COMPANY OWNER NAME

 

COMPANY OWNER ADDRESS

 

 

 

 

 

 

 

 

 

3 COMPANY OWNER NAME

 

COMPANY OWNER ADDRESS

 

 

 

 

 

 

 

 

 

4 COMPANY OWNER NAME

 

COMPANY OWNER ADDRESS

 

 

 

 

 

 

 

 

 

5 COMPANY OWNER NAME

COMPANY 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 company full time as being responsible for and in responsible charge of the professional engineering or professional surveying activities and decisions of the company.

Name, registration number, position of registrant in responsible charge

iMpOrTANT! Each registrant listed as in responsible charge must include an accompanying Company Afidavit of respon- sibility (PES 3012). If more than four registrants are in responsible charge, attach additional pages with the same information.

1 PRINTED NAME >> include notarized pES 3012

iNdiCATE All THAT ApplY

 

 

 

 

Director

 

 

Member

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

 

 

 

 

 

Partner

Manager

Oficer

 

2 PRINTED NAME >> include notarized pES 3012

iNdiCATE All THAT ApplY

 

 

 

 

Director

 

 

Member

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

 

 

 

 

 

Partner

Manager

Oficer

 

3 PRINTED NAME >> include notarized pES 3012

iNdiCATE All THAT ApplY

 

 

 

 

Director

 

 

Member

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

 

 

 

 

 

Partner

Manager

Oficer

 

4 PRINTED NAME >> include notarized pES 3012

iNdiCATE All THAT ApplY

 

 

 

 

Director

 

 

Member

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

 

 

 

 

 

Partner

Manager

Oficer

 

PES 3011 (Rev. 03/2012) 20120307

Page 2 of 4

Additional Ohio p.E., p.S. registrants employed by company

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

1 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

2 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

3 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

4 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

5 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

6 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

7 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

8 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

9 REGISTRANT NAME

 

 

 

COMPANY LOCATION ADDRESS

 

 

 

 

OHIO P.E. NUMBER

OHIO P.S. NUMBER

 

 

 

 

 

 

 

PES 3011 (Rev. 03/2012) 20120307

Page 3 of 4

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.

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.

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 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 Terrorist Exclusion List? ............................................................................................................................................

4.Have you solicited any individual for membership in an organization on the U.S. Department of State Terrorist 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?....................................................................................................................................................

AFFIANT SIGNATURE

AFFIANT TITLE

DATE SIGNED

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

NOTArY

Subscribed and sworn, or afirmed, to me this

 

day of

 

,

 

.

 

 

 

 

 

Witness my hand and seal hereon.

 

 

 

 

NOTARY SIGNATURE

 

 

 

 

MY COMMISSION EXPIRES

 

 

 

 

 

 

 

 

Deliver your completed Certiicate of Authorization application with afidavit(s) and fee to the Board’s address below.

CErTifiCATE Of AUTHOrizATiON

STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS 50 W BROAD ST STE 1820

COLUMBUS OH 43215-5905

 

 

 

 

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Questions?

EMAIL

pes.board@pes.ohio.gov

fAX

(614) 728-3059

U.S. TOll frEE

(877) 644-6364

PES 3011 (Rev. 03/2012) 20120307 Page 4 of 4

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

Company afidavit of responsibility

Complete a separate Company 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.

Company name, Ohio Board Certiicate of

Authorization number

BOARD USE ONLY

3012

COMPANY NAME >> SAME NAME as on Certiicate of Authorization application

OHIO CERTIFICATE OF AUTHORIZATION NUMBER >> 5-DIGItS

 

 

 

 

Professional services to be offered by company

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 company; that I am in responsible charge for and in responsible charge of the professional engineering or professional surveying activities and decisions of this company; and that I meet the requirements pursuant to Ohio Revised Code Chapter 4733 for such designation.

AFFIANT SIGNATUREDATE SIGNED

NOtArY

Subscribed and sworn, or afirmed, to me this

 

day of

 

,

 

.

 

 

 

 

 

Witness my hand and seal hereon.

 

 

 

 

NOTARY SIGNATURE

 

 

 

 

MY COMMISSION EXPIRES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Deliver your completed Company afidavit of responsibility to the Board’s address below.

cErtIfIcAtE Of AUthOrIzAtION

STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS

50 W BROAD ST STE 1820 COLUMBUS OH 43215-5905

Questions?

EMAIL

pes.board@pes.ohio.gov

fAX

(614) 728-3059

U.S. tOLL frEE

(877) 644-6364

PES 3012 (Rev. 03/2012) 20120307 Page 1 of 1

Document Properties

Fact Name Details
Form Purpose The PES 3011 form is used for companies seeking a Certificate of Authorization to provide professional engineering and surveying services in Ohio.
Governing Law This form is governed by the Ohio Revised Code Chapter 4733.
Application Requirements Applicants must submit a notarized PES 3011 form, a notarized company affidavit (PES 3012), and an active Ohio Secretary of State registration number.
Fees The application fee for new, name change, or additional service is $50. Annual renewal costs $25, while late renewal is $37.50.
Expiration Certificates of Authorization expire annually on June 30. Renewal is necessary to maintain active status.
Notification of Changes Companies must notify the Board within 30 days of any name or address changes, as well as changes in ownership or designated professionals.
Public Records Most documents submitted are public records and may be disclosed under official requests, per Ohio law.
Full-Time Requirement At least one designated professional must be a full-time employee, defined as working more than 30 hours per week.
Application Completeness Incomplete applications or those without the correct fee will be returned to the applicant.

Documents used along the form

The Ohio PES 3011 form is a crucial document for companies seeking a Certificate of Authorization to provide professional engineering and surveying services in Ohio. Along with this form, several other documents are typically required to ensure compliance with state regulations. Below is a list of additional forms and documents that are often used in conjunction with the Ohio PES 3011 form.

  • PES 3012 - Company Affidavit of Responsibility: This notarized affidavit must be completed for each professional engineer or surveyor designated as being in responsible charge of the company's activities. It attests to their qualifications and responsibilities.
  • Ohio Secretary of State Registration: Companies must provide an active registration number from the Ohio Secretary of State. This number verifies that the company is authorized to operate in Ohio.
  • DBA Registration (if applicable): If the company operates under a "doing business as" (DBA) name, it must also have a registration number for that name. This ensures that the DBA is recognized legally.
  • Application Fee Payment: A nonrefundable fee must accompany the application. This fee varies depending on the type of application, such as new, renewal, or name change.
  • Disclosure Statement: This document provides necessary information for the state board to fulfill its statutory duties. It outlines the requirement for truthful responses regarding affiliations and conduct.
  • Privacy Notice: Accompanying the disclosure statement, this notice informs applicants about the handling of their submitted information and its potential status as a public record.
  • Room Rental Agreement: The smarttemplates.net provides essential templates to help both landlords and tenants establish clear terms for room rentals in New York, ensuring a legally binding agreement is in place.
  • Notarized Signature: A notarized signature is required on the application and any accompanying affidavits, confirming the authenticity of the information provided.
  • Change Notification: Companies must notify the board of any changes to their name, address, or ownership within 30 days. This ensures that the board has up-to-date information about the company.
  • Annual Renewal Application: Companies must submit a renewal application each year to maintain their Certificate of Authorization. This process includes updating any necessary information and paying the renewal fee.

These documents work together to ensure that companies comply with Ohio's regulations for professional engineering and surveying. Properly completing and submitting these forms is essential for maintaining legal authorization to operate in the state.

Guidelines on Filling in Ohio Pes 3011

Filling out the Ohio PES 3011 form is an essential step for companies seeking a Certificate of Authorization to provide professional engineering or surveying services in Ohio. This process involves several key steps to ensure that all necessary information is provided accurately. Following these steps will help streamline your application and avoid delays.

  1. Obtain the Ohio PES 3011 form from the Ohio State Board of Registration for Professional Engineers and Surveyors website or their office.
  2. Fill out the application form completely, ensuring that all required fields are completed. If applicable, indicate whether you are applying for a new certificate, annual renewal, late renewal, additional service, or name change.
  3. Provide your company's active Ohio Secretary of State (SOS) charter or registration number. If using a DBA name, include that as well.
  4. List the owners of the company. If there are more than five owners, attach additional pages with the same information.
  5. Designate the registered individuals in responsible charge of the professional services. Each must be an Ohio-registered professional engineer or surveyor. Include their names, registration numbers, and positions.
  6. Complete the disclosure statement and privacy notice sections, answering all questions truthfully.
  7. Sign the notarized affidavit, confirming that you are authorized to prepare the application and that the information provided is accurate.
  8. Prepare the appropriate application fee. Make the payment using a check or money order made payable to the Treasurer, State of Ohio. Ensure the fee aligns with the type of application you are submitting.
  9. Submit your completed application, along with any required affidavits and the application fee, to the address provided on the form.

After submitting your application, it will be reviewed by the Board. If everything is in order, you will receive your Certificate of Authorization. If there are any issues, you may be contacted for further information or clarification. It's important to keep track of deadlines, especially the annual renewal date of June 30, to maintain your authorization status.

Common mistakes

Filling out the Ohio PES 3011 form can be a straightforward process, but many applicants stumble over common mistakes that can delay their application. One frequent error is failing to complete all required fields. Each section of the application must be filled out completely unless indicated otherwise. Leaving even a single field blank can result in the application being returned, causing unnecessary delays.

Another mistake often made is neglecting to include the appropriate fee. The application requires a nonrefundable fee, which varies depending on the type of application. For example, a new application or name change costs $50, while an annual renewal is $25. Ensure that the payment is made in U.S. funds and is payable to the Treasurer, State of Ohio. Without the correct fee, your application will be sent back.

Many applicants also overlook the necessity of notarized documents. The PES 3011 form must be accompanied by a notarized Certificate of Authorization application and a separate notarized Company affidavit of responsibility for each professional engineer and surveyor listed. Failing to provide these documents can lead to immediate rejection of the application.

Another common error is not checking the status of the company’s registration with the Ohio Secretary of State. It’s essential that the company holds an active registration to do business in Ohio. If your company is using a "doing business as" (DBA) name, an active registration number for that name is also required. Double-checking this information can save time and frustration.

Additionally, some applicants forget to notify the Board of any changes in the company's name or address within the required timeframe. Companies must inform the Board within 30 days of any changes. Failure to do so can lead to complications in maintaining an active status and compliance with state regulations.

Lastly, many people confuse the Certificate of Authorization with an individual license to practice engineering or surveying. It is crucial to understand that these are separate entities. The Certificate of Authorization is for the company, while individual licenses are required for the professionals working within that company. Being clear on this distinction can help streamline the application process and ensure compliance with state laws.

FAQ

  1. What is the Ohio PES 3011 form?

    The Ohio PES 3011 form is an application for a Certificate of Authorization, which companies need to provide professional engineering and/or surveying services in Ohio. This form is necessary for new applications, annual renewals, late renewals, adding additional services, or changing the company name.

  2. What documents must accompany the PES 3011 form?

    To complete the application, companies must submit a notarized PES 3011 form, a separate notarized Company Affidavit of Responsibility (PES 3012) for each professional engineer and surveyor in responsible charge, and an active Ohio Secretary of State charter or registration number. If a company operates under a DBA name, it must also provide a registration number for that name.

  3. What are the application fees associated with the PES 3011 form?

    The fees vary depending on the type of application. A new application, additional service request, or name change costs $50.00. An annual renewal costs $25.00, while a late annual renewal incurs a fee of $37.50. All fees must be paid in U.S. funds via check or money order made out to the Treasurer, State of Ohio.

  4. What happens if the application is incomplete or the fee is incorrect?

    Applications that are not filled out completely or do not include the correct fee will be returned. It is essential to ensure all required fields are completed to avoid delays in processing.

  5. When does the Certificate of Authorization expire?

    Certificates of Authorization expire annually on June 30. Companies must renew their certificate by this deadline to remain authorized to practice in Ohio. Failure to do so will result in the company being rendered inactive.

  6. What should a company do if there are changes in ownership or management?

    Companies are required to notify the Board within 30 days of any changes in the company’s name, address, partners, managers, officers, members, directors, shareholders, or designated professional engineers and surveyors. This ensures that the Board has up-to-date information regarding the company's structure and personnel.

  7. Is a Certificate of Authorization the same as an individual license to practice?

    No, a Certificate of Authorization is not the same as an individual license. The certificate allows a company to provide professional engineering or surveying services, while individual licenses are required for professionals to practice in their respective fields.

  8. How can companies contact the Ohio Secretary of State for more information?

    Companies can reach the Ohio Secretary of State's office through their website at www.sos.state.oh.us, or by telephone at (877) 767-6446 (toll-free) or (614) 466-2655 (Columbus metro). Email inquiries can be sent to pes.board@pes.ohio.gov.