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

1. FEE SCHEDULE:

Sole Proprietorships, GovernmentAgencies, and Utility Companies areExempt from fees.

APPLICABLE REFERENCES

NRS 625.177NAC 625.425

This space for Office Use Only

Date received:

For Period:

Make check payable to: Nevada Board of PE & LS

PROFESSIONAL SERVICES OFFERED

PRINCIPALS OF THE FIRM (list no more than three)

Name Discipline (if applicable) 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 tothe best of my knowledge

Signature Title Date

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

Reno, NV 89502

Date due: Amount Due

PRINCIPAL OFFICE

Number of Branch Offices(Offering Services in Nevada)

Corporation ($50)

Firm ($50)

Partnership ($50)

Sole Proprietorship ($0)

Utility Company ($0)

Government ($0)

Firm Name:

Address:

City, St., Zip:

Email Address:

Fax:

Telephone:

Civil Engineering

Mechanical Engineering

Electrical Engineering

Structural Engineering

Land Surveying

Other (list)

Firm Number:

Check Number:

Amount $ :

January 1, 20 $

01/01/ 12/31/to

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

This Space for Office Use Only

PROFESSIONAL SERVICES OFFERED

ENGINEERS/LAND SURVEYORS IN RESPONSIBLE CHARGE

Name Discipline NV License No.

Civil Engineering

Mechanical Engineering

Electrical Engineering

Structural Engineering

Land Surveying

Other (list)

BRANCH OFFICE

Firm Name:

Address:

City, St., Zip:

Email Address:

Fax:

Telephone:

Date Received:

Principal Firm Number :

Branch Office Number :

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):

• Corporationο All entities that have filed articles of incorporation

• Partnershipο General Partnershipο Limited Partnershipο Limited-Liability Partnership ο Limited-Liability Limited Partnership

• Firmο Limited-Liability Company ο Business Trust ο Other business entity required to file formation documents other than

incorporation.

• Sole Proprietorο 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 ofbusiness.

• The one registered principal office can be located in Nevada or can be locatedoutside of Nevada, but doing work in Nevada.

• Every business entity may have one or more branch offices, or may have nobranch office.

• Branch offices may be in or outside of Nevada, but must be registered under theprincipal 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 branchoffices. Submit a page two form for each branch office.

• A principal office is not also a branch office. Entities with one office have aprincipal office and no branch office(s).ο “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 aNevada license.

• “In Responsible Charge” is for all Nevada licensed professionals responsible forthe 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 withthe Board, the firm must file an application for renewal of its registration,accompanied by a fee of $50. NAC 625.425.5