Firm Registration This space for Office Use Only - NVBPELS

Firm Registration

Nevada Board of Professional Engineers and Land Surveyors 1755 E. Plumb Lane, Suite 258

Reno, NV 89502

For Period: 01/01/

Date due:

January 1, 20

to 12/31/

This space for Office Use Only Date received: Firm Number: Check Number: Amount $ :

Amount Due

$

Make check payable to: Nevada Board of PE & LS

PRINCIPAL OFFICE Firm Name: Address: City, St., Zip: Telephone: Fax: Email Address:

PROFESSIONAL SERVICES OFFERED

Civil Engineering

Other (list)

Mechanical Engineering

Electrical Engineering

Structural Engineering

Land Surveying

PRINCIPALS OF THE FIRM (list no more than three)

Name

Discipline (if applicable)

Page 1

1. FEE SCHEDULE:

Corporation ($50) Partnership ($50) Firm ($50) Sole Proprietorship ($0) Utility Company ($0) Government ($0)

Sole Proprietorships, Government Agencies, and Utility Companies are Exempt from fees.

APPLICABLE REFERENCES NRS 625.177 NAC 625.425

Number of Branch Offices

(Offering Services in Nevada)

NV License No. (if applicable)

ENGINEERS/LAND SURVEYORS IN RESPONSIBLE CHARGE

Name

Discipline

NV License No.

I declare, under penalty of perjury, that the information contained in this record is true and correct to the best of my knowledge

Signature

Title

Date

USE ADDITIONAL PAGES IF NECESSARY - FILL OUT PAGE 2 FOR EACH BRANCH OFFICE

BRANCH OFFICE Firm Name: Address: City, St., Zip: Telephone: Fax: Email Address:

PROFESSIONAL SERVICES OFFERED

Civil Engineering Mechanical Engineering Electrical Engineering Structural Engineering Land Surveying

Other (list)

ENGINEERS/LAND SURVEYORS IN RESPONSIBLE CHARGE

Name

Discipline

Page 2

This Space for Office Use Only Date Received: Principal Firm Number : Branch Office Number :

NV License No.

USE ADDITIONAL PAGES IF NECESSARY - FILL OUT PAGE 2 FOR EACH BRANCH OFFICE

GOT QUESTIONS?

PURPOSE: The purpose for corporate registration is to register all business entities that engage in engineering or land surveying services in Nevada, whether or not the work is performed in Nevada or out of state.

FEE: Some registered companies will be required to pay an annual fee. Others may be exempt from the required fee. Refer to the "Fee Schedule" on page one of the Firm Registration Form.

"Fee Schedule" business types (as relate to Secretary of State types):

? Corporation All entities that have filed articles of incorporation

? Partnership General Partnership Limited Partnership Limited-Liability Partnership Limited-Liability Limited Partnership

? Firm Limited-Liability Company Business Trust Other business entity required to file formation documents other than incorporation.

? Sole Proprietor A person not required to file formation documents, ie J Smith, PE

Principal Office vs. Branch Offices: ? Every business entity has one principal office. This is the location that is normally considered the corporate office, primary office or main place of business. ? The one registered principal office can be located in Nevada or can be located outside of Nevada, but doing work in Nevada. ? Every business entity may have one or more branch offices, or may have no branch office. ? Branch offices may be in or outside of Nevada, but must be registered under the principal office if performing work in Nevada or on a Nevada project. ? Page one of the registration form is for the principal office; page two for branch offices. Submit a page two form for each branch office. ? A principal office is not also a branch office. Entities with one office have a principal office and no branch office(s). "Number of branch offices" would be zero for a business with only one office.

Completing the Form:

? "Business Name" can be a person's name for Sole Proprietor. ? E-Mail address and telephone number should be for regular and normal contact. ? "Professional Services Offered" should list services provided in Nevada. ? "Principals of the Firm" is intended for owners, officers of the corporation, and

top-level managers, up to a limit of three. Principals do not necessarily have a Nevada license. ? "In Responsible Charge" is for all Nevada licensed professionals responsible for the work in Nevada.

Updating Form:

? Updated form must be refiled with Board when items listed change (e.g., Principal change, additional branch office, etc.)

Annual Renewal:

? Each year within 30 days after the anniversary date of a firm's registration with the Board, the firm must file an application for renewal of its registration, accompanied by a fee of $50. NAC 625.425.5

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