BOARD OF GOVERNORS OF THE LICENSED ARCHITECTS
LANDSCAPE ARCHITECTS AND REGISTERED INTERIOR DESIGNERS OF OKLAHOMA
P.O. Box 53430, Oklahoma City, OK 73152
Overnight Mailing Address * New Office Location: 220 NE 28th Street, Suite 150, Oklahoma City, OK 73105
PHONE (405) 949-2383 FAX (405) 949-1690
Address Correction Requested
Architect of Record: ______
Firm Name: ______
Address: ______
______
CA#: ______
CERTIFICATE OF AUTHORITY [CA] RENEWAL APPLICATION
THIS FORM MUST BE RETURNED. COPIES WILL NOT BE ACCEPTED.
Renewal fee for two-year period July 1, 2017 thru June 30, 2019
RENEWAL FEE - $325.00
The $325.00 biennial renewal fee is due by 4:30 p.m. in the Board office on or before June 30, 2017. This is a two (2) year CA renewal fee. Postmarks will not be accepted. All CA's are canceled July 1, 2017. Payment made on or after July 1st will require an additional late payment/reinstatement penalty of $225.00. Your canceled check will serve as your receipt. MAKE CHECKS PAYBLE TO OKLAHOMA BOARD OF ARCHITECTS. You are required to complete the following information to renew: YOU CANNOT RENEW YOUR CERTIFICATE OF AUTHORITY UNLESS YOU RENEW YOUR INDIVIDUAL LICENSE. You may send both forms in the same envelope, but pay with separate checks. If you need to change anything on this form, other than the address, you can go to www.ok.gov/architects for a CA Revision Form. Revisions are a separate process and require a separate fee. You are required to complete the following information to renew your Certificate of Authority.
1. Your LEGAL position in the firm:
[Check one]
o General Partner
o Director
o Partner
o Officer
o Shareholder
o Principal
o Manager [Applies to LLC]
o Member [Applies to LLC]
2. ___ YES ___ NO Has your firm been investigated, charged, or disciplined since or are you currently under investigation by any governing or licensing board or by any state or federal agency since 6/30/2015? If yes, submit details.
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. THERE HAVE BEEN NO CHANGES TO THE CURRENT CERTIFICATE OF AUTHORITY APPLICATION AND THE INFORMATION GIVEN REMAINS CORRECT AS LAST FILED WITH THE BOARD. I HAVE READ THE BOARD’S RULES (OAC 55:10-13) CONCERNING THE CERTIFICATE OF AUTHORITY AND AGREE TO INSURE COMPLIANCE BY THIS ENTITY.
______
[Signature of Architect/Landscape Architect of Record] [Date]
___ DO NOT WISH TO RENEW. WE NO LONGER CONTRACT IN OKLAHOMA USING THE FIRM’S NAME.
______ [Signature of Architect/Landscape Architect of Record] [Date]