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[]
[null,"様式第１号"]
[null,"　"]
[null,"　入札参加資格審査申請書（設計・測量・建設コンサルタント業務等）",{"$nulls":61},"行政庁記入欄（受付番号）",{"$nulls":26},"定時受付",{"$nulls":7},"随時（追加）受付"]
[]
[null,null,null,"海 部 南 部 消 防 組 合 管 理 者 　殿",{"$nulls":87},"令和　　 　 　年  　　　　月　　　　　　日"]
[]
[null,null,"令和６年度及び令和７年度に、貴消防組合が発注する設計、測量、建設コンサルタント業務等にかかる競争入札に参加したいので、指定の書類を添えて入札参加資格の審査を申請します。"]
[null,null,"なお、申請者及び受任者が地方自治法施行令第１６７条の４第１項（同令第１６７条の１１第１項において準用する場合を含む。）に該当するものでないこと並びにこの申請書及び添付書類の全ての記載事項は事実と相違ないことを誓約します。"]
[]
[]
[null,null,"１　申請者",{"$nulls":9},"業者番号",{"$nulls":59},"申請内容",{"$nulls":5},"新規",{"$nulls":4},"登録実績有",{"$nulls":6},"業種追加"]
[]
[null,null," 　（本店（本社））"]
[]
[{"$nulls":12},"郵便番号",{"$nulls":9},"－",{"$nulls":11},"Eメールアドレス"]
[null," "]
[{"$nulls":12},"所在地"]
[]
[{"$nulls":12},"商号又は名称\nのフリガナ"]
[]
[{"$nulls":12},"商号又は名称"]
[]
[{"$nulls":12},"代表者職氏名\n（個人の場合は氏名のみ記入）",{"$nulls":10},"（役職）",{"$nulls":32},"（氏名）"]
[]
[{"$nulls":12},"会社印及び\n代表者印",null,null,"会社印",{"$nulls":18},"代表者印",{"$nulls":19},"電話番号"]
[]
[]
[{"$nulls":54},"ＦＡＸ番号"]
[]
[]
[{"$nulls":55},"連絡先",{"$nulls":8},"部署名"]
[{"$nulls":55},"（代行者含む。）"]
[{"$nulls":64},"担当者名"]
[]
[{"$nulls":64},"直通電話番号"]
[]
[]
[]
[{"$nulls":12},"　"]
[null,null,"２　契約を締結する営業所\nを本店（本社）以外とする\n場合の委任事項",{"$nulls":9},"私は、次の者を代理人と定め、下記のとおり権限を委任します。",{"$nulls":42},"委任期間　　令和　　　　年　　　　月　　　　日　～　令和　　　　年　　　　月　　　　日まで"]
[{"$nulls":12},"　受任者",null,"所在地",{"$nulls":40},"委任事項　　１　入札及び見積に関する事項\n　　　　　　　　２　契約の締結、変更及び解除に関する事項\n    　　　　　　３　代金の請求及び受領に関する事項　\n    　　　　　　４　契約保証に関する事項\n    　　　　　　５　その他契約締結に関する事項  \n    　　　　　　６　共同企業体の結成に関する事項\n    　　　　　　７　前記各号に関する復代理人選任に関する事項　 　　　　　"]
[{"$nulls":12},"　"]
[null,null,"委任行為の有無",{"$nulls":11},"商号又\nは名称"]
[{"$nulls":88},"　 ※　１～７のうち、委任されていない事項\n　      について消して使用すること。"]
[null,null,"有",null,null,null,"無",{"$nulls":7},"代表者\n職氏名",{"$nulls":31},"㊞"]
[]
[]
[null,null,"３ 契約を締結する営業所",{"$nulls":9},"郵便番号",{"$nulls":9},"－",{"$nulls":13},"Eメールアドレス"]
[]
[{"$nulls":12},"所在地"]
[]
[{"$nulls":12},"商号又は名称\nのフリガナ"]
[]
[{"$nulls":12},"商号又は名称"]
[]
[{"$nulls":12},"代表者職氏名\n（個人の場合は氏名のみ記入）",{"$nulls":13},"（役職）",{"$nulls":29},"（氏名）"]
[]
[{"$nulls":12},"電話番号",{"$nulls":41},"ＦＡＸ番号"]

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[null,"様式第２号"]
[]
[]
[null,"○営業所における申請を希望する業種",{"$nulls":24},"　"]
[]
[]
[{"$nulls":32},"商号又は名称"]
[]
[null,null,"１　申請を希望する業種（太枠内に○を記入してください。）",{"$nulls":23},"２　登録等を受けている事業"]
[null,null,"業務","コード","業種",{"$nulls":7},"希望欄",null,null,"業務","コード","業種",{"$nulls":4},"希望欄",null,null,null,"登録事業名",{"$nulls":8},"登録番号",{"$nulls":4},"登録年月日"]
[null,null,"設計",1,"建築設計",{"$nulls":5},"　",{"$nulls":4},"地 調\n質 査",18,"地質調査",{"$nulls":8},"１．（１級・２級）建築士事務所　※１",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,2,"設備設計",{"$nulls":10},"コンサルタント\n補償",19,"土地調査",{"$nulls":8},"２．測量業者　※２",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,"測量",3,"一般測量",{"$nulls":11},20,"土地評価",{"$nulls":8},"３．建設コンサルタント",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,4,"航空写真測量",{"$nulls":11},21,"物件調査",{"$nulls":8},"４．地質調査業者",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,"建設コンサルタント",5,"河川、砂防及び海岸",{"$nulls":11},22,"事業損失",{"$nulls":8},"５．補償コンサルタント",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,6,"港湾及び空港",{"$nulls":21},"６．不動産鑑定業者",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,7,"道路",{"$nulls":21},"７．土地家屋調査士",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,8,"上水道及び工業用水道",{"$nulls":21},"８．司法書士",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,9,"下水道",{"$nulls":21},"９．計量証明事業者",{"$nulls":8},"　",{"$nulls":4},"　"]
[null,null,null,10,"農林土木",{"$nulls":21},"１．については１級・２級のどちらかを○で囲んでください。\n※１　設計の内、１．建築設計申請時に記入が必要です。\n　 ２　測量の内、３．一般測量及び４．航空写真測量申請時に記入が必要です。\n"]
[null,null,null,11,"森林土木"]
[null,null,null,12,"水産土木"]
[null,null,null,13,"造園"]
[null,null,null,14,"都市計画及び地方計画"]
[null,null,null,15,"土質及び基礎"]
[null,null,null,16,"鋼構造及びコンクリート"]
[null,null,null,17,"建設環境"]

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[null,"様式第３号",{"$nulls":32},"　"]
[]
[null,null,"　経　　　営　　　規　　　模　　　等　　　総　　　括　　　表",{"$nulls":38},"商号又は名称"]
[]
[null,null,"１　年間実績高",{"$nulls":15},"　",{"$nulls":5},"　",{"$nulls":9},"２　自己資本額"]
[null,null,"部門",null,"業務業種区分",{"$nulls":6},"ア　直前２年度分決算\n（千円）",{"$nulls":5},"イ　直前１年度分決算\n（千円）",{"$nulls":5},"ウ　直前２か年間の年間平均実績高\n（千円）",{"$nulls":10},"区　　　　　分",{"$nulls":4},"直前決算\n（千円）",{"$nulls":4},"剰余（欠損）金\n処分（千円）",{"$nulls":4},"計（千円）",{"$nulls":4},"決算後の増減\n（千円）",{"$nulls":4},"合計（千円）"]
[null,null,"設計",null,"１．建築設計",{"$nulls":29},"　払込資本金",{"$nulls":24},"※"]
[{"$nulls":4},"２．設備設計",{"$nulls":29},"　準備金・積立金"]
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[null,"２　この表は、直前２か年間の主な完成業務及び直前２か年間に着手した主な未完成業務について記載すること（消費税含む。）。"]
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