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[null,"          一般競争（指名競争）入札参加資格審査申請書（測量・建設コンサルタント等）"]
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[null,"貴組合で行われる北但ごみ処理施設整備・運営事業に係る競争入札に参加する資格の審査を申請します。"]
[null,"なお、この申請書及び添付書類の内容については、事実と相違しないことを誓約します。"]
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[null,null,null,"*欄については、記載しないこと。（以下同じ。）"]

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["コ④"]
[]
[null,"*","受付番号"]
[]
[null,"業　　　態　　　調　　　書（測量・建設コンサルタント等）"]
[]
[null,"登録部門及び希望業務の確認"]
[null,"登録部門及び希望業務","測量",null,null,"建築関係建設コンサルタント業務",{"$nulls":14},"土木関係建設コンサルタント業務",{"$nulls":29},"　　　　地　質　調　査","補償関係コンサルタント業務"]
[]
[null,null,"　　測量一般","　　地図の調整","　　航空測量","　　建築一般","　　意匠","　　構造","　　暖冷房","　　衛生","　　電気","　　建築積算","　　機械積算","　　電気積算","　　工事監理（建築）","　　工事監理（電気）","　　工事監理（機械）","　　調査","　　耐震診断","　　地区計画及び地域計画","建設コンサルタント",{"$nulls":20},"　　交通量調査","　　環境調査","　　経済調査","　　分析・解析","　　宅地造成","　　電算関係","　　計算業務","　　資料等整理","　　施工管理",null,"補償コンサルタント",{"$nulls":7},"　　不動産鑑定"]
[]
[{"$nulls":20},"　　河川、砂防及び海岸・海洋","　　港湾及び空港","　　電力土木","　　道路","　　鉄道","　　上水道及び工業用水","　　下水道","　　農業土木","　　森林土木","　　水産土木","　　廃棄物","　　造園","　　都市計画及び地方計画","　　地質","　　土質及び基礎","　　鋼構造及びコンクリート","　　トンネル","　　施工計画・施工設備及び積算","　　建設環境","　　機械","　　電気電子",{"$nulls":10},"　　土地調査","　　土地評価","　　物件","　　機械工作物","　　営業補償・特殊補償","　　事業損失","　　補償関連","　　総合補償"]
{"$rows_empty":21}
[null,"登録"]
[]
[]
[null,"希望"]
[]
[]
[]
[null,"記載要領"]
[null,null,1,null,"「測量業務」における「測量一般」、「地図の調整」及び「航空測量」を希望する方は、測量法第５５条の登録がなければ希望することはできません。"]
[null,null,2,null,"「建築関係建設コンサルタント業務」における「建築一般」を希望する方は、建築士法第２３条の登録がなければ希望することはできません。"]
[null,null,3,null,"「補償関係コンサルタント業務」における「不動産鑑定」を希望する方は、不動産の鑑定評価に関する法律第２２条による登録がなければ希望することはできません。"]
[null,null,4,null,"工事監理（建築）、工事監理（電気）及び工事監理（機械）については、自分の設計した事案以外の工事監理業務についても希望する場合、記載してください。"]
[]
[null,null,"※登録…国土交通省の建設コンサルタント及び補償コンサルタント登録規程に基づき登録を受けているものに「○」を付してください。"]
[null,null,"※希望…入札参加を希望するものに「○」を付してください。"]

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[null,"コ⑤"]
[]
[null,"*","受付番号"]
[]
[null,"営　　業　　所　　等　　一　　覧　　表"]
[]
[]
[null,"番号",null,"本社・本店、支店・営業所等の名称",{"$nulls":10},"郵便番号",{"$nulls":7},"所在地",{"$nulls":24},"電話番号（上段）"]
[]
[null,null,null,"代表者又は受任者",{"$nulls":43},"FAX番号（下段）"]
[]
[null,"本社・本店",{"$nulls":15},"-",{"$nulls":8},"道都府県"]
[]
[]
[]
[]
[]
[null,"支店・　　　　　　　　　　　　　　　営業所等",{"$nulls":15},"-",{"$nulls":8},"道都府県"]
[]
[]
[]
[]
[]
[]
[null,"記載要領"]
[null,null,1,null,"本表は、申請日現在で作成すること。"]
[null,null,2,null,"「支店・営業所等」欄には、申請を希望する業務について、組合と常時契約の締結ができる権限を委任された支店・営業所等について記入すること。"]
[{"$nulls":4},"（常時契約の締結ができる権限のない単なる連絡所は登録することはできません。）"]
[null,null,3,null,"「所在地」欄には、営業所の所在地を上段から左詰めで記載すること。"]
[null,null,4,null,"「電話・FAX番号」欄には、上段に電話番号を、下段にFAX番号を記載し、市外局番、市内局番及び番号は「－（ハイフン）」で区切ること。"]

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["コ⑥"]
[]
[null,"*","受付番号"]
[]
[null,"技　　術　　者　　経　　歴　　書"]
[]
[null,"（種類）"]
[]
[null,"氏　名",{"$nulls":4},"最終学歴",{"$nulls":9},"法令による免許等",{"$nulls":15},"実　務　経　歴",{"$nulls":14},"実務経験年月数"]
[{"$nulls":6},"学校の種類",{"$nulls":4},"専攻学科",{"$nulls":4},"名　　称",{"$nulls":7},"取得年月日"]
[{"$nulls":16},"\n",{"$nulls":10},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[{"$nulls":27},"年",null,"月",null,"日",{"$nulls":17},"年",null,null,"月"]
[null,"記載要領"]
[null,1,"本表は、土木、建築若しくは設備又は職種の各別に作成すること。"]
[null,null,"また、「氏名」の記載は、営業所（本店又は支店若しくは常時契約する事務所）ごとにまとめて行い、その直前に、（　）書きで当該営業所名を記載すること。"]
[null,2,"「学校の種類」の欄には、大学、高等専門学校等の別を記載すること。"]
[null,3,"「法令による免許等」の欄には、業務に関し法律又は命令による免許又は技術若しくは技能の認定を受けたものを記載すること。"]
[null,4,"「実務経歴」の欄には、最近のものから記載し、従事した職種及び地位を記載すること。"]

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["コ⑦"]
[]
[null,"*","受付番号"]
[]
[null,"測　量　等　実　績　調　書"]
[]
[null,"（業務の種類）"]
[]
[null,"発　注　者",{"$nulls":10},"元請又は\n下請の別",null,null,null,"件　名",{"$nulls":12},"測量等対象の規模等",{"$nulls":6},"業務履行場所のある都道府県名",{"$nulls":4},"請負代金の額",{"$nulls":5},"着　工　年　月"]
[{"$nulls":41},"（千円）",{"$nulls":5},"完成（予定）年月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":47},"平成",null,null,null,"年",null,null,"月"]
[]
[null,"記載要領"]
[null,null,1,null,"本表は、登録を受けた業種の各別又はその他の営業の種類の各別に作成すること。"]
[null,null,2,null,"本表は、直前2年間の主な完成業務及び直前2年間に着手した主な未完成業務について記入すること。"]
[null,null,3,null,"下請については、｢発注者」の欄には元請業者名を記入し、「件名」の欄には下請件名を記入すること。"]
[null,null,4,null,"「測量等対象の規模等」の欄には、例えば測量の面積・精度等、設計の階数・構造・延べ面積等を記入すること。"]
[null,null,5,null,"「請負代金の額」は、消費税込みの金額を記入すること。"]

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["共①"]
["委　　　任　　　状"]
[]
["平成　　年　　月　　日"]
[]
[]
[]
["北但行政事務組合"]
["管理者　中　貝　宗　治　　様"]
[]
[]
["　私は、下記の者を代理人と定め、下記の権限を委任します。"]
[]
["記"]
[]
["  １　入札および見積に関する件"]
["  ２　契約締結に関する件"]
["  ３　保証金の納付ならびに還付金の受領に関する件"]
["  ４　契約履行に関する件"]
["  ５　契約代金の請求および受領に関する件"]
["  ６　上記各号に関し復代理人選任及び解任に関する件"]
["  ７　期間　　　自　平成２５年　１月１６日"]
["　　　　  　　　至　平成２６年　３月３１日"]
[]
[]
[]
["  ■委任者"]
["　  　所在地又は住所"]
["　  　商号又は名称"]
["　  　代表者氏名　　　　　　　     　　　　　　　　　　　　　㊞　　"]
[]
["上記、委任の件承諾します。"]
[]
["  ■受任者"]
["  　　所在地又は住所"]
["  　　商号又は名称"]
["　  　受任者氏名　　　　　　　　　　     　　　　　　　　　　㊞　　"]

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["共②"]
["平成24・25年度　北但行政事務組合"]
["入札参加資格審査申請書 受付証（申請者保管用）"]
[]
["　　　　　　　　　　　　　　　　　　建設工事を申請される方は、毎年決算確定後すみやかに"]
["　　　　　　　　　　　　　　　　　　経営事項審査を受けることが条件となります。　　　　"]
[]
["申請者","所在地又は住所"]
[null,"商号又は名称"]
[null,"代表者"]
[]
[]
["あなたから申請のあった入札参加資格審査申請書を受付しました。",{"$nulls":6},"平成　　年　　月　　日"]
[{"$nulls":7},"北但行政事務組合"]
["受付　　　　番号"]
[]
[]
[]
["受付　　　　　　　　　者印","建設工事",null,null,"測量・建設コンサルタント等",null,null,"物品製造・役務の提供等"]
[]
[]
[]
[]
["記載要領"]
["１ 受付証及び受付票には、本店の所在地又は住所、商号又は名称及び代表者氏名を記入してください。"]
["２ この用紙の太線内は、記入しないでください。"]
["３ 記入する文字は、かい書でわかりやすく書いてください。"]
["４ 代表者印の押印の必要はありません。"]
[]
["（切り取らないでください）"]
[]
[]
["平成24・25年度　北但行政事務組合"]
["入札参加資格審査申請書 受付票（組合保管用）"]
[]
[{"$nulls":7},"平成　　年　　月　　日"]
[]
["商　号",{"$nulls":5},"代表者"]
["又　は"]
["名　称"]
["所在地"]
["又　は"]
["住　所"]
["提出書類","１．建設工事　　　２．測量・建設コンサルタント等　　　３．物品製造・役務の提供等"]
["※該当番号を○で囲む"]
[]
[]
["受付　　　　番号"]
[]
[]
[]
["申請　　　　　　　　書類　　　　　　　　　受領印","建設工事",null,null,"測量・建設コンサルタント等",null,null,"物品製造・役務の提供等"]

{"sheet":"提出書類チェック表","index":9,"n_rows":25,"n_cols":5,"rows_kept":25,"cut":false,"hidden":false,"merged":[[13,1,17,1],[13,2,17,2],[13,3,17,3],[18,0,22,0],[18,1,22,1],[18,2,22,2],[0,0,0,4],[3,0,3,1],[3,2,4,2],[3,3,4,3],[3,4,4,4],[18,4,22,4],[13,0,17,0]],"flags":["formulas_cached_only"]}
["提出書類チェック表（製本するファイルの表紙裏側に貼付）"]
[]
["《測量・建設コンサルタント等》　★印の書類は必ず組合様式を使用すること"]
["チェック欄",null,"書類番号","書類名","備考"]
["申請者","組合"]
[null,null,1,"一般競争（指名競争）入札参加資格審査申請書","組合様式（コ①～③）又は中央公契連統一様式"]
[null,null,2,"業態調書","組合様式（コ④）又は中央公契連統一様式"]
[null,null,3,"営業所等一覧表（営業所等がない（委任をしない）場合は本社のみ記載）","組合様式（コ⑤）又は中央公契連統一様式"]
[null,null,4,"技術者経歴書","組合様式（コ⑥）又は中央公契連統一様式"]
[null,null,5,"測量等実績調書","組合様式（コ⑦）又は中央公契連統一様式"]
[null,null,6,"登録証明書　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（営業に関し法律上必要とするもの）","写し可"]
[null,null,7,"使用印鑑届","任意様式"]
[null,null,8,"委任状★（※代理人を選任する場合のみ）","組合様式（共①）"]
[null,null,9,"納税証明書　　　　　　　　　　　　　　　　　　　　　　　　　　(未納税額がないことを証明するもの)","■書式その３関係…税務署で発行　写し可"]
[{"$nulls":4},"【法人の場合】"]
[{"$nulls":4},"　法人税並びに消費税及び地方消費税　　　　　　　　　　　　　　　　（様式その３の３）"]
[{"$nulls":4},"【個人の場合】"]
[{"$nulls":4},"　申告所得税並びに消費税及び地方消費税　　　　　　　　　　　　　　　　　　　　　　　　（様式その３の２）"]
[null,null,10,"【法人の場合】　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　","写し可"]
[null,null,null,"　商業登記簿謄本"]
[null,null,null,"【個人の場合】　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,null,null,"　身分証明書（本籍地の市区町村で発行）及び"]
[null,null,null,"　代表者の住民票"]
[null,null,11,"入札参加資格審査申請書受付証　　　　　　　　　　　　　　　　　　　　　　　　　　（受付証に本受付印を必要とする場合のみ）　　　　　　　","組合様式（共②）又は任意様式"]
[null,null,12,"返信用封筒（受付証に本受付印を必要とする場合のみ）","任意様式（切手貼付・宛名記載）"]