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["様式１－１"]
[]
["01",null,"１：新規",{"$nulls":4},"※02 受付番号",{"$nulls":63},"※03",{"$nulls":8},"業者コード",{"$nulls":84},"※",{"$nulls":4},"申請者",{"$nulls":22},"06",{"$nulls":4},"適格組",{"$nulls":12},"平成　　年　　月　　日"]
[null,null,"２：更新",{"$nulls":68},"　04",{"$nulls":8},"建設業許可番号",{"$nulls":37},"－",{"$nulls":46},"05",{"$nulls":4},"の規模",{"$nulls":27},"合証明",{"$nulls":12},"第　　　　　　　　　号"]
[]
["一般競争（指名競争）参加資格審査申請書（建設工事）"]
[]
[null,"平成28・29年度において、貴村で行われる建設工事に係る競争に参加する資格の審査を申請します。"]
[null,"なお、この申請書及び添付書類の内容については、事実と相違しないことを誓約します。"]
[]
[null,null,"平成　　　　年　　　　月　　　　日"]
[]
[{"$nulls":4},"天　川　村　長　　殿"]
[]
["07",null,null,null,"本社(店)郵便番号",{"$nulls":29},"－"]
[]
[]
[{"$nulls":4},"フリガナ"]
[]
["08",null,null,null,"本社(店)住所"]
[]
[]
[{"$nulls":4},"フリガナ"]
[]
["09",null,null,null,"商号又は名称"]
[]
[]
["10",null,null,null,"役職"]
[]
[]
[{"$nulls":4},"フリガナ",{"$nulls":136},"フリガナ"]
[]
[{"$nulls":4},"代表者氏名",{"$nulls":99},"㊞",{"$nulls":30},11,{"$nulls":6},"担当者氏名"]
[]
[]
["12",null,null,null,"本社(店)電話番号",{"$nulls":130},13,{"$nulls":6},"担当者電話番号"]
[]
[{"$nulls":192},"（内線番号",{"$nulls":54},"）"]
[]
["14",null,null,null,"本社(店)FAX番号",{"$nulls":105},15,{"$nulls":6},"メールアドレス"]
[]
[]
["16",null,null,null,"外資状況",{"$nulls":12},"１　外国籍会社",{"$nulls":45},"２　日本国籍会社",{"$nulls":43},"３　日本国籍会社",{"$nulls":86},17,{"$nulls":6},"営業年数",{"$nulls":38},"年"]
[{"$nulls":16},"［国名：　　　　　　］",{"$nulls":45},"［国名：　　　　　　］",{"$nulls":43},"［国名：　　　　　］",{"$nulls":38},"［国名：　　　　　］"]
[]
[{"$nulls":62},"（外資比率：100％）",{"$nulls":43},"（外資比率：　　％）",{"$nulls":38},"（外資比率：　　％）",{"$nulls":48},18,{"$nulls":6},"総職員数\n（人）"]
[]
[]
["※欄については、記入しないこと（以下同じ）。"]

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["様式２"]
[]
["※ 受付番号",{"$nulls":58},"※ 業者コード"]
[]
["営　　業　　所　　一　　覧　　表"]
[]
["番　号",null,null,null,"営　業　所　名　称",{"$nulls":29},"郵 便\n\n番 号",{"$nulls":7},"所　　　　在　　　　地",{"$nulls":47},"電話番号（上段）",{"$nulls":23},"建　設　業　許　可　業　種　（上段）"]
[{"$nulls":114},"土",null,"建",null,"大",null,"左",null,"と",null,"石",null,"屋",null,"電",null,"管",null,"タ",null,"鋼",null,"筋",null,"舗",null,"しゅ",null,"板",null,"ガ",null,"塗",null,"防",null,"内",null,"機",null,"絶",null,"通",null,"園",null,"井",null,"具",null,"水",null,"消",null,"清"]
[{"$nulls":90},"FAX番号（下段）",{"$nulls":23},"営　　　業　　　区　　　域　（下段）"]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
[{"$nulls":40},"-"]
[]
["記載要領"]
[null,"１　本表は、申請日現在で作成すること。"]
[null,"２　「営業所名称」欄には、経営事項審査を受けた建設業の許可を有するすべての本店又は支店等営業所の名称を記載すること。"]
[null,"３　「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,"４　「電話・ＦＡＸ番号」欄には、上段に電話番号を、下段にＦＡＸ番号を記載することとし、市外局番、市内局番及び番号は、「－（ハイフン）」で区切ること。"]
[null,"５　「建設業許可業種」（上段）の欄には、「営業所名称」欄に記入した営業所に対応する経営事項審査を受けた建設業許可業種の欄に○印を付すること。"]
[null,"６　「営業区域」（下段）の欄には、その営業所が営業する区域について、該当するコードを記載すること。"]

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["選択様式１"]
[]
["※ 受付番号",{"$nulls":56},"※ 業者コード"]
[]
["業　　態　　調　　書"]
[]
[null,"有資格技術職員内訳"]
["施　　工　　管　　理　　技　　士",null,null,null,"検　定　種　目",{"$nulls":19},"級 別 ・ 種 別",{"$nulls":21},"人　　　数",{"$nulls":23},"施　　工　　管　　理　　技　　士",null,null,null,"技 術 部 門",{"$nulls":13},"選　　　択　　　科　　　目",{"$nulls":33},"人　　　数"]
[{"$nulls":4},"建設機械施工技士",{"$nulls":19},"一級",{"$nulls":49},"建設",{"$nulls":13},"「鋼構造物及びコンクリート」"]
[{"$nulls":24},"二級",{"$nulls":63},"その他"]
[{"$nulls":4},"土木施工管理技士",{"$nulls":19},"一級",{"$nulls":49},"農業",{"$nulls":13},"「農業土木」"]
[{"$nulls":24},"二級",{"$nulls":8},"土木",{"$nulls":40},"電気・電子部門",{"$nulls":13},"－"]
[{"$nulls":33},"鋼構造物塗装",{"$nulls":40},"機械",{"$nulls":13},"「流体機械」又は「暖冷房及び冷凍機械」"]
[{"$nulls":33},"薬液注入",{"$nulls":54},"その他"]
[{"$nulls":4},"建築施工管理技士",{"$nulls":19},"一級",{"$nulls":49},"水道",{"$nulls":13},"「上水道及び工業用水道」"]
[{"$nulls":24},"二級",{"$nulls":8},"建築",{"$nulls":54},"その他"]
[{"$nulls":33},"躯体",{"$nulls":40},"林業",{"$nulls":13},"「林業」"]
[{"$nulls":33},"仕上げ",{"$nulls":54},"「森林土木」"]
[{"$nulls":4},"電気工事施工管理技士",{"$nulls":19},"一級",{"$nulls":49},"衛生工学",{"$nulls":13},"「水質管理」"]
[{"$nulls":24},"二級",{"$nulls":63},"「汚物処理」又は「廃棄物処理」"]
[{"$nulls":4},"管工事施工技士",{"$nulls":19},"一級",{"$nulls":63},"その他"]
[{"$nulls":24},"二級",{"$nulls":49},"建築士",{"$nulls":13},"一級建築士"]
[{"$nulls":4},"造園施工技士",{"$nulls":19},"一級",{"$nulls":63},"二級建築士"]
[{"$nulls":24},"二級",{"$nulls":63},"水道建築士"]
[{"$nulls":74},"建設設備資格者",{"$nulls":13},"－"]
[{"$nulls":9},"監 理 技 術 者 資 格 者 証 所 持 者 数",{"$nulls":78},"合　　　　　　　　　計"]
[{"$nulls":88},"実　　　　人　　　　数"]
[]
["設備工事比率（％）",{"$nulls":16},"電気設備工事における屋内の工事の比率"]
[{"$nulls":17},"暖冷房衛生設備工事における暖冷房設備工事の比率"]

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["選択様式２"]
[]
["※ 受付番号",{"$nulls":56},"※ 業者コード"]
[]
["工　　　事　　　経　　　歴　　　書"]
[]
["（建設工事の種類）",{"$nulls":45},"工事"]
[]
["注　　文　　者",{"$nulls":19},"元請又は\n下請の別",{"$nulls":9},"工　　　　　事　　　　　名",{"$nulls":42},"工事場所のある\n都 道 府 県 名",{"$nulls":15},"配置技術者氏名",{"$nulls":15},"請　負　代　金　の　額　（千円）",{"$nulls":38},"着工年月"]
[{"$nulls":124},"うち（　　　　　）",{"$nulls":19},"完成（予定）年月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[{"$nulls":143},"　　　年　　　月"]
[]
[{"$nulls":84},"合　計",{"$nulls":7},"件",{"$nulls":12},"千円",{"$nulls":18},"千円"]
["記載要領"]
["１",null,null,null,"本表は、許可を受けた建設業の種類に対応した建設工事の種類ごとに作成すること。"]
["２",null,null,null,"本表は、直前１年間の完成工事について、記載された請負代金の額（工事進行基準を採用している場合、その工事進行基準が適用される完成工事については、記載要領６により付記されたその完成工事高）の合計が、完成工事に係る請負代金"]
[{"$nulls":4},"の額（工事進行基準を採用している場合、その工事進行基準が適用される完成工事については、その完成工事高。記載要領６を除き、以下同じ。）の合計のおおむね７割を越えるところまで、請負代金の額の大きい順に記載し、それに続けて、"]
[{"$nulls":4},"直前１年間に着工した主な未完成工事について記載すること。"]
["３",null,null,null,"共同企業体（ＪＶ）として行った工事については、「元請又は下請の区別」の欄に、当該区別に係る記載のほかＪＶと付記すること。"]
["４",null,null,null,"「配置技術者氏名」の欄には、完成工事について、法第26条第１項又は第２項の規定により直前１年間に置かれた者の氏名をすべて記載すること。"]
["５",null,null,null,"土木一式工事についてこの表を作成する際には、「請負代金の額」の欄中「うち（　）」の括弧内に「ＰＣ」と記載し、各工事ごとにプレストレストコンクリート工事に該当する請負代金の額を記載すること。"]
[{"$nulls":4},"また、とび・土工・コンクリート工事について作成する際には「法面処理」、鋼構造物工事について作成する際には「鋼橋上部｣について同様に記載すること。"]
["６",null,null,null,"工事進行基準を採用している場合、その工事進行基準が適用される完成工事については、「請負代金の額」の欄に、その完成工事高を括弧書きで付記すること。"]
["７",null,null,null,"「合計」の欄には、完成工事の件数及び完成工事に係る請負代金の額の合計（記載要領５によりＰＣ等について請負代金の額を記載する場合には、当該区分に係る額の合計を含む。）を記載すること。"]
["８",null,null,null,"下請工事については、「注文者」の欄には、直接注文した元請負人の商号又は名称を記載し、「工事名」の欄には、下請工事の名称を記載すること。"]
["９",null,null,null,"「請負代金の額」は、消費税抜きの金額を記載すること。"]
["10",null,null,null,"本表は、経営事項審査申請書に添付した工事経歴書（直前１年分）の写しで代替することができる。"]

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[{"$nulls":10},"使　用　印　鑑　届"]
[]
[]
[]
[{"$nulls":10},"使用印",{"$nulls":14},"実印"]
[]
[]
[]
[null,null,"上記の印鑑は、入札見積に参加し、契約の締結並びに代金の請求受領のために使用したいのでお届けします。"]
[]
[{"$nulls":8},"平成　　　年　　　月　　　日"]
[]
[{"$nulls":17},"住所"]
[{"$nulls":17},"商号又は名称"]
[{"$nulls":17},"代表者",{"$nulls":22},"印"]

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[]
[{"$nulls":4},"委　　任　　状"]
[]
[]
[]
[{"$nulls":26},"平成　　年　　月　　日"]
[]
[null,null,"天　川　村　長　　殿"]
[]
[{"$nulls":11},"住所"]
[{"$nulls":7},"（委任者）",null,null,null,"商号又は名称"]
[{"$nulls":11},"氏名",{"$nulls":13},"印"]
[]
[]
[null,"　下記の者を代理人と定め、天川村との間に行う契約について次の権限を委任します。"]
[]
[]
[{"$nulls":14},"記"]
[]
[]
[{"$nulls":6},"住所"]
[null,null,"（受任者）",null,null,null,"商号又は名称"]
[{"$nulls":6},"氏名",{"$nulls":18},"印"]
[{"$nulls":6},"電話番号"]
[{"$nulls":6},"ＦＡＸ番号"]
[]
[{"$nulls":6},"１　入札及び見積に関する一切の権限"]
[null,null,"（委任事項）",null,null,null,"２　復代理人選定に関する一切の権限"]
[{"$nulls":6},"３　契約の締結及び契約の履行に関する一切の権限"]
[{"$nulls":6},"４　代金の請求及び受領に関する一切の権限"]
[]
[]
[null,null,"（委任期間）",null,null,null,"平成　　年　　月　　日　から",{"$nulls":9},"平成　　年　　月　　日　まで"]