Fillable Application For Electronic Wiring Certificate System E- Cert (North Dakota State Electrical Board)

Fill Online, Printable, Fillable, Blank Application For Electronic Wiring Certificate System E- Cert (North Dakota State Electrical Board) Form

Use Fill to complete blank online NORTH DAKOTA STATE ELECTRICAL BOARD pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Application For Electronic Wiring Certificate System E- Cert (North Dakota State Electrical Board)

On average this form takes 5 minutes to complete

The Application For Electronic Wiring Certificate System E- Cert (North Dakota State Electrical Board) form is 2 pages long and contains:

  • 0 signatures
  • 4 check-boxes
  • 17 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your North Dakota State Electrical Board forms online.

BROWSE NORTH DAKOTA STATE ELECTRICAL BOARD FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Current Status
☐ New User ☐ Current E-Cert User – Changing Payment Option
Contracting Master/Class B Name
License Number
Social Security Number
Business Name
Address
City
State
ZIP Code
Telephone Number
Email Address
• There are two (2) options for paying on certificates:
o Deposit Account – a non-interest bearing account set up with the ND State Electrical Board. Funds need
to be available in this account in order to submit the final electrical wiring certificate(s). Funds may be
submitted via a check with deposit slip to the ND State Electrical Board.
o ACH (Automatic Clearing House) is an automatic withdrawal from your bank account.
Payment Options
☐ Deposit – Mail in check with deposit slip.
☐ ACH - Attach voided check and complete information below to automatically withdraw payment from a
financial institution.
Complete information below for ACH (Automatic Clearing House) authorizations.
Financial Institution Name
Federal Identification Number
Business Name
Date
Place Voided Check Here
APPLICATION FOR ELECTRONIC WIRING CERTIFICATE SYSTEM (E-CERT)
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 11845 (12-2020)
SFN 11845 (12-2020)
Page 2 of 4
I, as named above, affirm that I am a Master/Class B Electrician, in good standing of the State of North Dakota. By
submitting this application and receiving a password, I agree to adhere to the North Dakota State Electrical Board’s order
authorizing electronic certificate filing, and the rules for the North Dakota State Electrical Board’s e-Cert system. I am
providing the above information as a condition of receiving my password.
I, as named above, have read and understand the following rules:
• I will use this system for certificates filed with the North Dakota State Electrical Board.
• I understand that the use of my login ID, password and typed name on the certificate has the same legal effect as
my original manually affixed signature on the certificate being submitted. Each use of my password for filing
wiring certificates certifies that the certificate meets the requirements of the North Dakota Century Code by me or
my authorized employee(s).
• I agree to protect and secure the confidentiality of my login and password. Therefore, if I have reason to believe
that my password has been compromised, it is my responsibility to immediately notify the North Dakota State
Electrical Board.
• I understand the e-Cert system will allow my account to be automatically charged the applicable inspection fee by
the ND State Electrical Board after the filing of the electrical wiring certificate.
• I understand the ND State Electrical Board has sole discretion to terminate access to the e-Cert system at any
time by giving advance notice to the ND Contracting Master/Class B Electrician.
• I understand and agree to the terms and conditions of the e-Cert system as specified on pages 3-4.
I authorize investigation and certify that all statements contained in this application are true and accurate. In compliance
with the Federal Privacy Act of 1974, the disclosure of the individual’s social security number on this form is mandatory
pursuant to North Dakota Century Code 43-50-02. The individual’s social security number is used for identification and
verification purposes. Penalty for the applicant not including the social security number on their application will cause the
application to not be processed.
Signature of Master/Class B Electrician
Date
FOR OFFICE USE ONLY
☐ New User ☐ Current E-Cert User - Changing Payment Option
Login ID
Password
Approved By
Date
Submit complete application to:
North Dakota State Electrical Board Phone: 701-328-9522
PO Box 7335 Fax: 701-328-9524
Bismarck, ND 58507 Email address: electric@nd.gov
Website: www.ndseb.com
SFN 11845 (12-2020)
Page 3 of 4
INTRODUCTION
The individual (herein referred to as “ND Contracting Master/Class B”) identified above has submitted an application to the
North Dakota State Electrical Board to establish an account for funds associated with the purchases of electrical wiring
certificates and conduct of other business transactions with the North Dakota State Electrical Board. ND Contracting
Master/Class B has requested that the North Dakota State Electrical Board provides ND Contracting Master/Class B with
limited on-line access to the North Dakota State Electrical Board e-Cert system for electronic data relevant to the ND
Contracting Master/Class B’s Electrical Wiring Certificates. Pursuant to NDCC 43-09-19, the North Dakota State
Electrical Board hereby grants ND Contracting Master/Class B such limited access subject to the following terms and
conditions.
TERMS & CONDITIONS
LIMITATION OF DURATION AND TERMINATION OF ACCESS
Upon approval by the North Dakota State Electrical Board, ND Contracting Master/Class B will be provided with limited
on-line access to North Dakota State Electrical Board’s e-Cert system for electronic data relevant to ND Contracting
Master/Class B’s electrical wiring certificates. Such access will be granted for an indefinite period of time unless
terminated by ND Contracting Master/Class B or by the North Dakota State Electrical Board as specified below. The
North Dakota State Electrical Board has the sole discretion to terminate ND Contracting Master/Class B’s access to the e-
Cert system at any time by giving advance notice to ND Contracting Master/Class B. If access is so terminated, ND
Contracting Master/Class B shall be liable for any actions, liabilities and/or expenses associated with the access provided
prior to the effective date of termination. The North Dakota State Electrical Board shall have the right to terminate ND
Contracting Master/Class B’s access as set forth herein if the ND Contracting Master/Class B license or registration
issued by the North Dakota State Electrical Board to ND Contracting Master/Class B is inactivated, suspended, or
revoked in excess of seven (7) working days.
DISCLAIMER OF WARRANTY
There are no express or implied warranties, including the implied warranties of merchantability and fitness for a particular
purpose, regarding the limited access to e-Cert system provided by the North Dakota State Electrical Board. The North
Dakota State Electrical Board does not warrant that the data or functions contained in the e-Cert system will meet ND
Contracting Master/Class B’s needs or requirements or that operation/access will be uninterrupted or error free. The
North Dakota State Electrical Board shall not be responsible for any damages with respect to any claim arising from the e-
Cert system access provided by the North Dakota State Electrical Board, even if the North Dakota State Electrical Board
has been or is hereafter advised of the possibility of such damages.
ND CONTRACTING MASTER/CLASS B DUTIES
ND Contracting Master/Class B agrees that ND Contracting Master/Class B will:
1. Maintain computer equipment and internet access necessary to allow computer link-up with the North Dakota
State Electrical Board’s computer system.
2. Be wholly responsible for the selection, acquisition, operation, and maintenance of equipment and software,
including the internet access software (internet browser), necessary for this access, and for all costs, expenses
and payments associated with such access, including payments to their own internet service provider (ISP) for
internet connectivity services.
3. Safeguard the data received or accessed according to the terms specified in the Data Confidentiality and Security
section below.
4. Promptly notify the North Dakota State Electrical Board in writing upon its decision to terminate its access to e-
Cert system.
5. Promptly respond, without charge, to any questions or surveys conducted by the North Dakota State Electrical
Board regarding the access or services.
SFN 11845 (12-2020)
Page 4 of 4
DATA CONFIDENTIALITY AND SECURITY
• ND Contracting Master/Class B warrants that ND Contracting Master/Class B’s employees will maintain as
confidential all computer date information, computer-oriented systems, systems-related data, software, study
finding and recommendations, financial affairs, passwords, access codes and other resources and any other
information which may be classified as confidential according to agency polices or state laws.
• ND Contracting Master/Class B will not disclose such confidential data or information without the written consent
of the North Dakota State Electrical Board except as may be required by Law.
• ND Contracting Master/Class B agrees to utilize reasonable security procedures and protections designed to
assure that confidential information is not disclosed to persons other than the employees of ND Contracting
Master/Class B who have a legitimate need to know and have agreed to such confidentiality requirements.
• ND Contracting Master/Class B shall include such requirements of confidentiality for all employees of ND
Contracting Master/Class B that have access to the confidential data.
• ND Contracting Master/Class B will protect North Dakota State Electrical Board information resources from
unauthorized use, disclosure, alteration, or destruction whether accidental or intentional. ND Contracting
Master/Class B understands that personal access authorizations may be reviewed, updated or revoked at any
time by the North Dakota State Electrical Board.
ND Contracting Master/Class B will adhere to the following computer security practices:
1. Change passwords if ND Contracting Master/Class B feels there is a confidentiality compromise.
2. Avoid easily guessed passwords or passwords that have a personal meaning, e.g., spouse’s or child’s name.
Combination of letters, numbers and special characters are best.
3. Keeping password(s) a secret; not posting passwords on terminals or leaving them on desks. Each employee of
the ND Contracting Master/Class B who has authorized access to the e-Cert system is directly responsible for
protecting the confidentiality of passwords and other electronic data processing (EDP) security procedures
required to be established by the ND Contracting Master/Class B.
4. Login IDs are assigned by the North Dakota State Electrical Board to the ND Contracting Master/Class B. The
Contracting Master/Class B is responsible for actions taken or messages sent using assigned login IDs. No other
person should be allowed to use an assigned login ID.
5. Logoff or lock the terminal before leaving it. Terminals can be locked by the use of password protected screen
savers, or other workstation or network access login requirements as may be established by the ND Contracting
Master/Class B.
6. Any instance which appears to compromise data security will be reported to the North Dakota State Electrical
Board.
ND CONTRACTING MASTER/CLASS B’S CERTIFICATIONS AND ASSURANCES
ND Contracting Master/Class B understands that the limited access to the North Dakota State Electrical Board e-Cert
system granted by North Dakota State Electrical Board to Contracting Master/Class B is restricted only to the electronic
data relevant to ND Contracting Master/Class B’s Electrical Wiring Certificates and in association with the establishment
of an account for transfer of funds between the North Dakota State Electrical Board and ND Contracting Master/Class B
for the purchase of electrical wiring certificates and other related business transactions.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Application For Electronic Wiring Certificate System E- Cert (North Dakota State Electrical Board)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 April 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document