The Ohio 3011 form serves a critical function for firms in the fields of professional engineering and surveying seeking to legally operate within Ohio. Mandated by the State Board of Registration for Professional Engineers and Surveyors, this comprehensive document necessitates the inclusion of a notarized Certificate of Authorization application, individual affidavits of responsibility for designated professionals, an active Ohio Secretary of State charter or registration, and the appropriate application fee. It plays an instrumental role in ensuring that firms comply with state regulations, maintain high standards of professional accountability, and provide quality services to the public.
The Ohio 3011 form serves as a critical document for firms seeking to obtain or renew a Certificate of Authorization from the State Board of Registration for Professional Engineers and Surveyors, enabling them to provide professional engineering and/or surveying services within Ohio. This comprehensive form outlines various requirements such as the necessity for the application to be notarized, the submission of a separate notarized affidavit of responsibility for designated professional engineers and surveyors, and an active Ohio Secretary of State charter or registration number. It also specifies application fees ranging from $25 for annual renewals to $50 for new, additional services, or name change applications, while late annual renewals incur a $37.50 fee. Furthermore, the form emphasizes the importance of full completion, timely renewal by the June 30 deadline to avoid inactive status, and prompt notification to the Board regarding any firm changes. Besides operational directives, it includes disclosures related to public records and a notarized affidavit section addressing compliance with certain legal stipulations, culminating in a thorough process that ensures only qualified entities offer engineering and surveying services in Ohio.
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?
EMAiL
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
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
ADDRESS LINE 1
>> DO NOt USE AGENt ADDrESS
ADDRESS LINE 2
>> ONLY if needed
PES 3011 (Rev. 03/2011)
Page 1 of 4
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
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
2 PRINTED NAME >> include notarized PES 3012
iNDiCAtE ALL tHAt APPLY
3 PRINTED NAME >> include notarized PES 3012
4 PRINTED NAME >> include notarized PES 3012
Page 2 of 4
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
2 REGISTRANT NAME
3 REGISTRANT NAME
4 REGISTRANT NAME
5 REGISTRANT NAME
6 REGISTRANT NAME
7 REGISTRANT NAME
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.
Page 3 of 4
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
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?....................................................................................................................................................
YES NO
AFFIANT SIGNATURE
AFFIANT TITLE
DATE SIGNED
NOtArY
Subscribed and sworn, or afirmed, to me this
day of
,
.
Witness my hand and seal hereon.
NOTARY SIGNATURE
MY COMMISSION EXPIRES
L
A
S
E
Y
R
T
ON
N
O
Page 4 of 4
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
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
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.
PES 3012 (Rev. 03/2011) 20110301
Once you have decided to apply for Ohio's Certificate of Authorization to either start offering professional engineering and/or surveying services, renew your existing authorization, make a name change, or add an additional service, it is crucial to follow the application process meticulously. This meticulousness ensures compliance with state requirements and helps avoid delays or rejections due to incomplete information or incorrect fee submission. To assist in this endeavor, below is a thorough, step-by-step guide covering how to fill out the form 3011 accurately. Remember, this form, along with any relevant affidavits and the appropriate fee, must be sent to the State Board of Registration for Professional Engineers and Surveyors for processing.
Adhering to these steps carefully will help ensure that your submission is complete and compliant with Ohio's requirements, facilitating a smoother process in obtaining or renewing your Certificate of Authorization.
What is the purpose of the Ohio 3011 form?
The Ohio 3011 form is used by firms that need a Certificate of Authorization to offer or provide professional engineering and/or professional surveying services in the state of Ohio. This form is essential for new applications, annual renewal, late annual renewal, adding an additional service, or name changes for firms in these professional fields.
What are the requirements for submitting the Ohio 3011 form?
To submit the Ohio 3011 form, firms must include a notarized Certificate of Authorization application (PES 3011), a separate notarized Firm affidavit of responsibility for each professional engineer and professional surveyor in charge, an active Ohio Secretary of State charter or registration number, and the appropriate application fee. All fields in the application must be completed unless indicated otherwise. Incomplete applications or those without the correct fee will be returned.
How much is the application fee for the Ohio 3011 form?
The application fee for the Ohio 3011 form varies based on the purpose of the application. For new applications or adding an additional service or a name change, the fee is $50.00. The annual renewal fee is $25.00, and the late annual renewal fee is $37.50. Fees should be made payable in U.S. funds to the treasurer, State of Ohio.
Where should the completed Ohio 3011 form be sent?
Completed Ohio 3011 forms, along with the notarized affidavit(s) and appropriate fee, should be sent to the Certificate of Authorization, Ohio Engineers and Surveyors Board, 50 W Broad St Ste 1820, Columbus, OH 43215-5905. Firms can also contact the Board via email at pes.board@pes.ohio.gov or by fax at (614) 728-3059 for further assistance or inquiries.
What happens if the Certificate of Authorization is not renewed by the deadline?
Firms that fail to renew their Certificate of Authorization by the June 30 deadline will become inactive and unauthorized to practice in the state of Ohio. It is crucial for firms to comply with these regulations to avoid any disruption in their ability to provide professional engineering or surveying services. Additionally, firms must notify the Board within 30 days of any changes in the firm's name or address, changes in partners, managers, officers, members, directors, shareholders, or changes in designated professional engineers or surveyors.
Not obtaining or incorrectly entering the active Ohio Secretary of State charter or registration number. This number is mandatory for validating the firm's authorization to operate under its name or its Doing Business As (DBA) name in Ohio. Failing to include it, or entering an inactive or incorrect number, leads to the rejection of the application.
Submitting an incomplete Firm Affidavit of Responsibility (PES 3012) for each professional designated in charge. It is crucial for these affidavits to be fully completed and notarized for each professional engineer and professional surveyor designated to be in responsible charge. Missing or partially filled affidavits compromise the application's validity.
Incorrect application fee or method of payment. The application mandates fees to be paid by check or money order in U.S. funds to the Treasurer, State of Ohio. Missteps often include using incorrect amounts for the intended application type or attempting to use an unacceptable payment method, which results in the application being returned.
Failure to report changes within the specified 30 days. Firms must promptly notify the Board of any changes in firm name, address, or alterations in partners, managers, officers, members, directors, shareholders, designated professional engineers, professional surveyors, or ownership. Not adhering to this requirement can lead to unauthorized practice penalties due to outdated or incorrect information being on record.
When preparing for professional engineering or surveying services in Ohio, completing the PES 3011 form is just the beginning. Several other documents often accompany the Certificate of Authorization application, ensuring compliance and smooth operations within the state.
Collectively, these documents form a comprehensive packet that establishes a firm's credibility, professional integrity, and legal standing to offer engineering or surveying services in Ohio. Ensuring all paperwork is accurate, up-to-date, and fully completed is vital for successful business operations in the state.
The Ohio PES 3010 form, which provides general instructions for applying for a Certificate of Authorization, bears resemblance to the Application for Business Entity License or Registration often utilized by various state boards for accountancy. This similarity exists due to both forms requiring detailed entity information, such as business type and structure, alongside the submission of an application fee. Furthermore, both mandate the disclosure of those in responsible charge within the company, ensuring that professional standards are maintained and overseen by qualified individuals.
Similarly, the PES 3012 form, which is a Firm Affidavit of Responsibility for each engineer or surveyor in charge, shares commonalities with the Individual Qualifier Form found in some states' contractor licensing applications. Both documents require the identification and notarization of individuals responsible for professional services offered by the business. Both forms are pivotal in verifying that those in key operational roles are credentialed, maintaining the integrity and quality of the services provided.
The requirement on the Ohio PES 3011 form for an active registration with the Ohio Secretary of State parallels the step in the Business License Application process where proof of state business registration is necessary. This common requirement underscores the importance of formal recognition and authorization to operate within the state, ensuring that all entities are legally constituted and accountable under state laws.
Another document, the Change of Address/Name Form that various state agencies offer, matches the Ohio 3011 form's provision for notifying changes in firm details. Important for updating records to ensure compliance and effective communication, these sections in each document facilitate the management of current information within official registries, highlighting the critical nature of accurate and current business identification for regulatory compliance.
During the application for professional licenses, the Disclosure Statement and Privacy Notice section of the Ohio PES 3011 form echoes the disclosures found in licensure applications across fields such as medical, legal, and real estate professions. This similarity is found in the mutual requirement for applicants to acknowledge the public nature of their submission and the potential for certain information to be made accessible under public records law. This transparency ensures that the professional's qualifications and legal standing are available for public verification and trust-building.
The Notarized Affidavit within the Ohio PES 3011 form, requiring a sworn statement about the truthfulness of the application, is mirrored in various legal and financial documents, such as affidavits of identity or sworn financial disclosure forms. This similarity underscores the emphasis on honesty and integrity within the process, anchoring the legal and ethical responsibilities of the applicant to provide accurate and truthful information, a fundamental component of trust between professionals and the regulatory bodies overseeing them.
Lastly, the Ohio PES 3011’s aspect of listing additional service offerings or structural changes in the entity shares a likeness with Addendum or Amendment Forms used in contract law. These forms allow for the official update or revision of previously agreed-upon terms, reflecting changes in service scope or business structure. Like their counterparts, such modifications are crucial for maintaining current and lawful operations, ensuring that all parties are informed and agreements remain valid under the evolving conditions of business.
When completing the Ohio 3011 form for a Certificate of Authorization, there are several key do's and don'ts to bear in mind. These guidelines help ensure the application process is smooth and the form is accepted without issues.
When it comes to navigating the complexities of legal forms, understanding the Ohio 3011 Certificate of Authorization application can be challenging for firms looking to offer professional engineering and surveying services within the state. To help clarify, let's address seven common misconceptions about this application:
It's only for new firms: The Ohio 3011 form is not exclusively for new businesses. It is also required for annual renewals, name changes, adding additional services, and for late annual renewals. Understanding each section is critical to submit the form correctly based on your firm’s specific needs.
DBA (Doing Business As) doesn’t need a separate Ohio SOS number: If your firm operates under a DBA name, a separate active Ohio Secretary of State (SOS) charter or registration number for that DBA is mandatory. Firms must ensure both the firm's name and any DBA names are properly registered and active with the Ohio SOS.
Online submissions are accepted: Currently, the application process for a Certificate of Authorization requires mailing the completed form alongside the appropriate fee and notarized Affidavit(s) of Responsibility. Despite the digital era, this process remains strictly paper-based.
Only one professional in charge needs to fill out an affidavit: Each full-time employee designated in responsible charge of professional engineering or surveying activities must complete and submit a notarized PES 3012 (Affidavit of Responsibility). This ensures that all persons in charge meet the state’s requirements.
Application fees are negotiable: The fees for submitting an Ohio 3011 application are fixed. New applications, additional services, or name changes are set at a $50.00 fee. Annual renewals cost $25.00, and late annual renewals are charged at $37.50. These fees are non-negotiable and payable in U.S. funds to the Treasurer, State of Ohio.
Firm type doesn’t influence the application: The form requires firms to designate their structure, such as a corporation, LLC, partnership, or professional association. This categorization is important as it may influence liability and responsibility within the scope of Ohio law.
An application can be processed without an Ohio Secretary of State number: An active Ohio SOS charter or registration number is essential for application approval. This number validates the business's legal standing within the state, ensuring it is authorized to conduct business under its name or DBA.
By dispelling these misconceptions, firms can navigate the application process more smoothly, ensuring compliance with the Ohio State Board of Registration for Professional Engineers and Surveyors. Remember, accurate and complete applications facilitate a quicker approval process, helping your firm stay compliant and ready to offer professional services in Ohio.
Filling out and using the Ohio 3011 form, which is crucial for firms seeking a Certificate of Authorization to offer professional engineering and/or surveying services in Ohio, involves a detailed process. Understanding the key takeaways can streamline compliance and ensure timely approval. Here are the essential points to remember:
Submitting the Ohio 3011 form accurately and with all required documentation is vital for firms offering engineering or surveying services in Ohio to operate legally. Observing these key points ensures compliance with the State Board of Registration for Professional Engineers and Surveyors' regulations.
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