The Ohio PES 3011 form is an application for a Certificate of Authorization, required for companies that provide professional engineering and surveying services in Ohio. This form is essential for new applications, annual renewals, and changes such as adding services or updating company names. To ensure compliance and avoid delays, it is important to fill out the form accurately and submit it with the appropriate fees.
Ready to get started? Fill out the form by clicking the button below.
The Ohio PES 3011 form is a crucial document for companies seeking to provide professional engineering and surveying services in Ohio. This application serves multiple purposes, including new applications, annual renewals, late renewals, and changes in service or company name. To complete the form, applicants must provide a notarized Certificate of Authorization application, along with a separate notarized Company Affidavit of Responsibility for each designated professional engineer or surveyor in responsible charge. Additionally, an active registration number from the Ohio Secretary of State is necessary for the company and any "doing business as" (DBA) names. Application fees vary depending on the type of submission, with a standard fee of $50 for new applications or additional services, and $25 for annual renewals. It's important to note that all information must be filled out completely, as incomplete applications will be returned. The form also outlines key responsibilities, such as notifying the Board of any changes in company structure or ownership within 30 days. Failure to renew the Certificate of Authorization by the June 30 deadline will result in the company being rendered inactive, emphasizing the importance of timely compliance with these regulations.
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
[email protected]
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
ADDRESS LINE 1 >> dO NOT USE AgENT AddrESS
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
3 COMPANY OWNER NAME
4 COMPANY OWNER NAME
5 COMPANY 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 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
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 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
3 REGISTRANT NAME
4 REGISTRANT NAME
5 REGISTRANT NAME
6 REGISTRANT NAME
7 REGISTRANT NAME
8 REGISTRANT NAME
9 REGISTRANT NAME
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
NOTArY
Subscribed and sworn, or afirmed, to me this
day of
,
.
Witness my hand and seal hereon.
NOTARY SIGNATURE
MY COMMISSION EXPIRES
L N
E
A
O
S
T
Y
R
N
L
EMAIL
PES 3011 (Rev. 03/2012) 20120307 Page 4 of 4
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
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
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
ON
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
U.S. tOLL frEE
PES 3012 (Rev. 03/2012) 20120307 Page 1 of 1
Completing 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 form must be filled out accurately and submitted along with additional documentation and fees. Below are the steps to guide you through the process of filling out the form.
After submission, it is important to monitor the status of your application. Ensure that all required documents are included, as incomplete applications may be returned. If you have any questions during the process, you can contact the Board directly for assistance.
The Ohio PES 3011 form is an application for a Certificate of Authorization. This certificate is necessary for companies that wish to provide or offer professional engineering and/or professional surveying services in the state of Ohio. The form is used for new applications, annual renewals, late renewals, adding additional services, or changing the company name.
To successfully submit the PES 3011 form, the following documents are required:
The fees for the application vary depending on the type of application being submitted:
These fees are non-refundable and must be included with the application.
The Certificate of Authorization must be renewed annually. All certificates expire on June 30 each year. It is crucial to renew before this deadline to maintain active status and the ability to practice in Ohio.
If the Certificate of Authorization is not renewed by the June 30 deadline, the company will become inactive and unauthorized to practice professional engineering or surveying in Ohio. It is essential to renew on time to avoid interruptions in service.
For additional information, you can contact the Ohio Secretary of State’s office through the following methods:
Incomplete Application: Many applicants fail to fill out all required fields. Every section must be completed unless specified otherwise.
Incorrect Fees: Submitting the wrong application fee is a common mistake. Make sure to include the correct amount based on the type of application.
Notarization Issues: Some applicants neglect to notarize the Certificate of Authorization application (PES 3011) or the Company Affidavit of Responsibility (PES 3012). Both documents must be properly notarized.
Missing Secretary of State Registration: Failing to provide an active Ohio Secretary of State charter or registration number can lead to application rejection. Ensure this number is included.
Overlooking DBA Requirements: If using a "doing business as" (DBA) name, applicants often forget to include the necessary registration number for the DBA. This is crucial for compliance.
Failure to Update Information: Companies sometimes forget to notify the Board of any changes to their name or address within the required 30-day period. This can result in complications.
Confusing Certificate of Authorization with Individual Licenses: Some applicants mistakenly believe that the Certificate of Authorization is the same as an individual license to practice engineering or surveying. It is essential to understand the difference.
The Ohio PES 3011 form is a critical 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 often required to ensure compliance with state regulations. Below is a list of these documents, each described briefly to clarify their purpose and importance.
These documents collectively support the application process for a Certificate of Authorization in Ohio. Ensuring that each is properly completed and submitted will help facilitate a smoother approval process for companies looking to provide professional engineering and surveying services in the state.
The Ohio PES 3012 form, known as the Company Affidavit of Responsibility, is closely related to the PES 3011 form. Both documents are essential for companies offering professional engineering and surveying services in Ohio. While the PES 3011 form serves as the application for a Certificate of Authorization, the PES 3012 form specifically requires a notarized affidavit from each professional engineer and surveyor designated in responsible charge. This ensures that the individuals overseeing the engineering or surveying activities are recognized and accountable, thus reinforcing the integrity of the professional services provided.
The Certificate of Good Standing is another document that shares similarities with the PES 3011 form. This certificate verifies that a business entity is legally registered and compliant with state regulations. Like the PES 3011, which requires proof of an active Ohio Secretary of State charter or registration number, the Certificate of Good Standing serves as evidence that a company is authorized to operate in Ohio. Both documents play a critical role in establishing the legitimacy and operational status of a business within the professional engineering and surveying fields.
The Professional License Application is also akin to the PES 3011 form. This application is submitted by individuals seeking to obtain a professional license in engineering or surveying. Similar to the PES 3011, it requires detailed information about the applicant, including educational background and work experience. Both forms are crucial in ensuring that only qualified individuals and companies are permitted to practice in their respective fields, thereby upholding professional standards and public safety.
The Business Registration Form further parallels the PES 3011 form. This document is necessary for any business entity to register with the state before conducting operations. Like the PES 3011, the Business Registration Form requires the inclusion of specific information about the company, such as its name, address, and ownership structure. Both forms are foundational to establishing a business legally, ensuring compliance with state regulations, and facilitating the delivery of professional services.
Lastly, the Annual Renewal Application for Professional Licenses is similar to the PES 3011 form in its purpose and structure. Both documents require timely submission to maintain active status—whether for a company’s Certificate of Authorization or an individual’s professional license. They involve similar processes, including the payment of fees and the provision of updated information. This parallel emphasizes the importance of ongoing compliance and accountability in the professional engineering and surveying sectors.
When filling out the Ohio PES 3011 form, keep the following guidelines in mind:
This form can be used for various purposes, including annual renewals, late renewals, adding services, or changing the company name. It is not limited to new applications.
All companies offering professional engineering or surveying services in Ohio, regardless of size, must complete and submit this form to obtain a Certificate of Authorization.
The fee varies depending on the type of application. For instance, a new application or adding a service costs $50, while an annual renewal costs $25, and a late renewal costs $37.50.
Approval is not guaranteed. Applications can be returned if they are incomplete or do not include the correct fee. It is essential to ensure all required information is provided.
When filling out and using the Ohio PES 3011 form, keep these key takeaways in mind: