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{"sheet":"申請書（様式1）","index":0,"n_rows":53,"n_cols":205,"rows_kept":53,"cut":false,"hidden":false,"merged":[[5,0,5,11],[5,43,5,71],[5,100,5,132],[5,133,5,137],[5,72,5,76],[5,77,5,81],[5,20,5,24],[5,25,5,29],[5,30,5,34],[5,15,5,19],[16,3,16,10],[51,31,51,71],[52,31,52,71],[19,29,19,31],[19,33,19,35],[19,37,19,39],[15,15,17,20],[15,21,17,26],[19,21,19,23],[21,15,23,20],[51,199,51,244],[52,199,52,244],[51,72,51,198],[52,72,52,198],[25,13,25,15],[25,17,25,19],[25,37,25,39],[25,41,25,43],[25,45,25,47],[25,49,25,51],[16,0,16,1],[48,0,48,1],[15,27,17,32],[15,57,17,62],[15,33,17,38],[15,39,17,44],[15,45,17,50],[15,51,17,56],[19,13,19,15],[19,17,19,19],[21,21,23,26],[19,25,19,27],[21,27,23,32],[40,0,40,1],[28,0,28,1],[22,0,22,1],[19,3,21,10],[25,3,27,10],[34,3,34,10],[37,3,39,10],[40,3,40,10],[34,0,34,1],[19,41,19,43],[19,45,19,47],[19,49,19,51],[19,53,19,55],[25,21,25,23],[25,25,25,27],[25,29,25,31],[25,33,25,35],[19,57,19,59],[19,61,19,63],[19,65,19,67],[19,69,19,71],[19,73,19,75],[19,77,19,79],[19,81,19,83],[19,85,19,87],[19,89,19,91],[19,93,19,95],[19,97,19,99],[19,101,19,103],[19,105,19,107],[19,109,19,111],[19,113,19,115],[19,117,19,119],[19,121,19,123],[19,125,19,127],[19,129,19,131],[19,133,19,135],[19,137,19,139],[19,141,19,143],[19,145,19,147],[19,149,19,151],[19,153,19,155],[19,157,19,159],[19,161,19,163],[19,165,19,167],[19,169,19,171],[19,173,19,175],[19,177,19,179],[19,181,19,183],[19,185,19,187],[19,189,19,191],[19,193,19,195],[19,197,19,199],[19,201,19,203],[19,205,19,207],[19,209,19,211],[19,213,19,215],[19,217,19,219],[19,221,19,223],[19,225,19,227],[19,229,19,231],[21,33,23,38],[21,39,23,44],[21,45,23,50],[21,51,23,56],[21,57,23,62],[21,63,23,68],[21,69,23,74],[21,75,23,80],[21,81,23,86],[21,87,23,92],[21,93,23,98],[21,99,23,104],[21,105,23,110],[21,111,23,116],[21,117,23,122],[21,123,23,128],[21,129,23,134],[21,135,23,140],[21,177,23,182],[21,183,23,188],[21,141,23,146],[21,147,23,152],[21,153,23,158],[21,159,23,164],[21,213,23,218],[21,219,23,224],[21,225,23,230],[22,3,22,10],[21,189,23,194],[21,195,23,200],[21,201,23,206],[21,207,23,212],[21,165,23,170],[21,171,23,176],[25,53,25,55],[25,57,25,59],[25,61,25,63],[25,65,25,67],[25,69,25,71],[25,73,25,75],[25,77,25,79],[25,81,25,83],[25,85,25,87],[25,89,25,91],[25,93,25,95],[25,97,25,99],[25,101,25,103],[25,105,25,107],[25,109,25,111],[25,113,25,115],[25,117,25,119],[25,121,25,123],[25,125,25,127],[25,129,25,131],[25,133,25,135],[25,137,25,139],[25,141,25,143],[25,145,25,147],[25,149,25,151],[25,153,25,155],[25,157,25,159],[25,161,25,163],[25,165,25,167],[25,169,25,171],[25,173,25,175],[25,177,25,179],[25,181,25,183],[25,185,25,187],[25,189,25,191],[25,193,25,195],[25,197,25,199],[25,201,25,203],[25,205,25,207],[25,209,25,211],[25,213,25,215],[25,217,25,219],[25,221,25,223],[25,225,25,227],[25,229,25,231],[27,15,29,20],[27,21,29,26],[27,27,29,32],[27,33,29,38],[27,39,29,44],[27,45,29,50],[27,51,29,56],[27,57,29,62],[27,63,29,68],[27,69,29,74],[27,75,29,80],[27,81,29,86],[27,87,29,92],[27,93,29,98],[27,99,29,104],[27,105,29,110],[27,111,29,116],[27,117,29,122],[27,123,29,128],[27,129,29,134],[27,135,29,140],[27,177,29,182],[27,183,29,188],[27,141,29,146],[27,147,29,152],[27,153,29,158],[27,159,29,164],[27,213,29,218],[27,219,29,224],[27,225,29,230],[28,3,28,10],[27,189,29,194],[27,195,29,200],[27,201,29,206],[27,207,29,212],[27,165,29,170],[27,171,29,176],[31,110,31,112],[31,114,31,116],[31,3,33,10],[33,27,35,32],[33,33,35,38],[34,12,34,24],[33,39,35,44],[33,45,35,50],[33,51,35,56],[33,57,35,62],[31,118,31,120],[31,122,31,124],[31,126,31,128],[31,130,31,132],[31,134,31,136],[31,138,31,140],[31,142,31,144],[31,146,31,148],[31,166,31,168],[31,170,31,172],[31,150,31,152],[31,154,31,156],[31,158,31,160],[31,162,31,164],[33,63,35,68],[33,69,35,74],[33,75,35,80],[33,81,35,86],[33,113,35,118],[33,119,35,124],[33,125,35,130],[34,94,34,106],[33,131,35,136],[33,137,35,142],[33,143,35,148],[33,149,35,154],[33,195,35,200],[33,155,35,160],[33,161,35,166],[33,167,35,172],[37,13,37,15],[37,17,37,19],[37,37,37,39],[37,41,37,43],[37,21,37,23],[37,25,37,27],[37,29,37,31],[37,33,37,35],[37,45,37,47],[37,49,37,51],[39,63,41,68],[37,69,37,71],[39,69,41,74],[37,73,37,75],[37,53,37,55],[37,57,37,59],[37,61,37,63],[37,65,37,67],[39,15,41,20],[39,21,41,26],[39,27,41,32],[39,33,41,38],[39,39,41,44],[39,45,41,50],[39,51,41,56],[39,57,41,62],[44,4,44,5],[43,63,45,68],[43,69,45,74],[43,27,45,32],[43,33,45,38],[43,39,45,44],[43,45,45,50],[43,127,45,132],[43,133,45,138],[43,139,45,144],[44,96,44,100],[44,105,44,121],[43,145,45,150],[43,151,45,156],[43,157,45,162],[43,163,45,168],[43,193,45,198],[43,169,45,174],[43,175,45,180],[43,181,45,186],[43,187,45,192],[52,3,52,30],[51,3,51,30],[48,3,48,30],[43,75,45,80],[43,81,45,86],[43,51,45,56],[43,57,45,62],[43,15,45,20],[43,21,45,26],[44,7,44,11],[2,0,2,4],[2,5,2,10],[2,11,2,25],[2,33,2,47],[2,108,2,127],[2,128,2,147],[2,93,2,107],[2,67,2,85],[2,48,2,66],[5,158,5,162],[2,148,2,167],[2,168,2,187],[4,181,5,203],[4,204,4,253],[5,204,5,253],[5,163,5,167],[5,168,5,172],[5,173,5,177],[7,0,7,255],[5,82,5,86],[5,87,5,91],[5,92,5,96],[5,12,5,14],[5,138,5,142],[5,35,5,39],[5,143,5,147],[5,148,5,152],[5,153,5,157]],"flags":["formulas_cached_only"]}
["様式１"]
[]
["01",{"$nulls":4},"１　定期",{"$nulls":5},"２　随時",{"$nulls":21},"02",{"$nulls":14},"１　新規",{"$nulls":18},"２　更新",{"$nulls":25},"03",{"$nulls":14},"１ 組　合",{"$nulls":19},"２ 公益法人",{"$nulls":19},"３ 個　人",{"$nulls":19},"４ その他"]
[]
[{"$nulls":181},"07　適格組\n　　合証明",{"$nulls":22},"平成　　　年　　　月　　　日"]
["※04 受付機関コード",{"$nulls":42},"※05 受付番号",{"$nulls":56},"※06 業者コード",{"$nulls":103},"第　　　　　　　　　　　　号"]
[]
["一般競争（指名競争）参加資格審査申請書（物品製造等）"]
[]
[null,"平成28・29年度において、貴村で行われる物品の製造等に係る競争に参加する資格の審査を申請します。"]
[null,"なお、この申請書及び添付書類の内容については、事実と相違しないことを誓約します。"]
[]
[null,null,"平成　　　　年　　　　月　　　　日"]
[{"$nulls":5},"天　川　村　長　殿"]
[]
[{"$nulls":33},"－"]
["08",null,null,"郵便番号"]
[]
[]
[null,null,null,"フリガナ"]
[]
[]
["09",null,null,"住所"]
[]
[]
[null,null,null,"フリガナ"]
[]
[]
["10",null,null,"商号又は名称"]
[]
[]
[null,null,null,"フリガナ"]
[]
[{"$nulls":195},"㊞"]
["11",null,null,"代表者氏名",{"$nulls":8},"（役職）",{"$nulls":81},"（氏名）"]
[]
[]
[null,null,null,"フリガナ"]
[]
[]
["12",null,null,"担当者氏名"]
[]
[]
[]
[{"$nulls":4},"13",null,null,"電話番号",{"$nulls":88},"14",{"$nulls":8},"FAX番号"]
[]
[]
[]
["15",null,null,"主たる事業の種類"]
[]
[]
[null,null,null,"１．物品の製造",{"$nulls":27},"２．物品の販売",{"$nulls":40},"３．役務の提供等",{"$nulls":126},"４．物品の買受け"]
[null,null,null,"［a ゴム製品・b その他］",{"$nulls":27},"［c 卸売・d 小売］",{"$nulls":40},"［e ｿﾌﾄｳｪｱ業又は情報処理ｻｰﾋﾞｽ業・f 旅館業・g ｻｰﾋﾞｽ業・h その他］",{"$nulls":126},"［I 立木・j　その他］"]

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["様式２"]
[]
["※04 受付機関コード",{"$nulls":29},"※05 受付番号",{"$nulls":24},"※06 業者コード"]
[]
[{"$nulls":12},"①直前々年度分決算",{"$nulls":29},"②直前年度分決算",{"$nulls":29},"\n③前２か年間の平均実績高\n\n\n　　　　　　　　　　　　（千円）"]
[null,18,{"$nulls":10},"　　年　　月　　から",{"$nulls":14},"　　年　　月　　から",{"$nulls":14},"　　年　　月　　から",{"$nulls":14},"　　年　　月　　から"]
[null,null,null,"製造・販売等\n実績",{"$nulls":8},"　　年　　月　　まで",{"$nulls":14},"　　年　　月　　まで",{"$nulls":14},"　　年　　月　　まで",{"$nulls":14},"　　年　　月　　まで"]
[{"$nulls":12},"　　　　　　　（千円）",{"$nulls":14},"　　　　　　　（千円）",{"$nulls":14},"　　　　　　　（千円）",{"$nulls":14},"　　　　　　　（千円）"]
[]
[]
[{"$nulls":4},"区　　分",{"$nulls":15},"直前決算時\n　　　（千円）",{"$nulls":11},"剰余（欠損）＿＿\n金処分　（千円）",{"$nulls":11},"決算後の増減＿\n額　　（千円）",{"$nulls":11},"合　　　　　　　計\n　　　　　　　　　　　（千円）",{"$nulls":28},"１　外国籍会社"]
[null,19,{"$nulls":79},20]
[null,"　自己資本額",null,null,"①　（うち外国資本）",{"$nulls":51},"（",{"$nulls":19},"）",{"$nulls":4},"　外　資　状　況",null,null,null,"　［国名：　　　　　　　］"]
[" ",null,null,null,"　払込資本金",{"$nulls":80},"２　日本国籍会社"]
[{"$nulls":4},"②準備金・積立金",{"$nulls":80},"　［国名：　　　　　　　］"]
[{"$nulls":4},"③次期繰越利益（欠損）金",{"$nulls":80},"　　（比率：100％）"]
[{"$nulls":4},"④　　　　計",{"$nulls":80},"３　日本国籍会社"]
[{"$nulls":85},"　［国名：　　　　　　　］\n　　（比率：　　％）"]
[{"$nulls":7},"流　動\n比　率",{"$nulls":4},"流動資産（　　　　　　　　千円）",{"$nulls":20},"×100＝",{"$nulls":10},"(％)"]
[null,21,null,"経営\n状況",{"$nulls":46},22,null,"営業年数",{"$nulls":7},23,null," 常勤職員の人数"]
[{"$nulls":44},"．",{"$nulls":40},"　［国名：　　　　　　　］\n　　（比率：　　％）"]
[{"$nulls":12},"流動負債（　　　　　　　　千円）"]
[]
[{"$nulls":7},"① 機械装置類（千円）",{"$nulls":15},"② 運搬具類（千円）",{"$nulls":15},"③ 工具その他（千円）",{"$nulls":15},"④　合　　　計（千円）"]
[null,24,null,"設備\nの額"]
[]
[]
[null,25]
[null,null,null,"主要\n設備\nの\n規模"]

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[null,"様式３"]
[]
["※04　受付機関コード",{"$nulls":28},"※05　受付番号",{"$nulls":25},"※06　業者コード"]
[]
["１７",null,null,null,"希望する資格の種類等"]
[]
["資格\nの\n種類",{"$nulls":6},"物品の製造",{"$nulls":33},"資格\nの\n種類",{"$nulls":6},"物　　　品　　　の　　　販　　　売",{"$nulls":33},"資格\nの種類",{"$nulls":6},"役　　　務　　　の　　　提　　　供"]
[]
[]
["営　業　品　目",{"$nulls":6},"101　　衣服・その他繊維製品類",{"$nulls":33},"営　業　品　目",{"$nulls":6},"201　　衣服・その他繊維製品類",{"$nulls":33},"営　業　品　目",{"$nulls":6},"301　　広告・宣伝"]
[{"$nulls":7},"102　　ゴム・皮革・プラスチック製品類",{"$nulls":40},"202　　ゴム・皮革・プラスチック製品類",{"$nulls":40},"302　　写真・製図"]
[{"$nulls":7},"103　　窯業・土石製品類",{"$nulls":40},"203　　窯業・土石製品類",{"$nulls":40},"303　　調査・研究"]
[{"$nulls":7},"104　　非鉄金属・金属製品類",{"$nulls":40},"204　　非鉄金属・金属製品類",{"$nulls":40},"304　　情報処理"]
[{"$nulls":7},"105　　フォーム印刷",{"$nulls":40},"205　　フォーム印刷",{"$nulls":40},"305　　翻訳・通訳・速記"]
[{"$nulls":7},"106　　その他印刷類",{"$nulls":40},"206　　その他印刷類",{"$nulls":40},"306　　ソフトウェア開発"]
[{"$nulls":7},"107　　図書類",{"$nulls":40},"207　　図書類",{"$nulls":40},"307　　会場等の借り上げ"]
[{"$nulls":7},"108　　電子出版物類",{"$nulls":40},"208　　電子出版物類",{"$nulls":40},"308　　賃貸借"]
[{"$nulls":7},"109　　紙・紙加工品類",{"$nulls":40},"209　　紙・紙加工品類",{"$nulls":40},"309　　建物管理等各種保守管理"]
[{"$nulls":7},"110　　車輌類",{"$nulls":40},"210　　車輌類",{"$nulls":40},"310　　運送"]
[{"$nulls":7},"111　　その他輸送・輸送機械器具類",{"$nulls":40},"211　　その他輸送・輸送機械器具類",{"$nulls":40},"311　　車輌整備"]
[{"$nulls":7},"112　　船舶類",{"$nulls":40},"212　　船舶類",{"$nulls":40},"312　　船舶整備"]
[{"$nulls":7},"113　　燃料類",{"$nulls":40},"213　　燃料類",{"$nulls":40},"313　　電子出版"]
[{"$nulls":7},"114　　家具・什器類",{"$nulls":40},"214　　家具・什器類",{"$nulls":40},"314　　防衛用装備品類の整備"]
[{"$nulls":7},"115　　一般・産業用機械類",{"$nulls":40},"215　　一般・産業用機械類",{"$nulls":40},"315　　その他"]
[{"$nulls":7},"116　　電気・通信機械類",{"$nulls":40},"216　　電気・通信機械類"]
[{"$nulls":7},"117　　電子計算機類（パソコン）",{"$nulls":40},"217　　電子計算機類(パソコン)",{"$nulls":33},"資格\nの\n種類",{"$nulls":6},"物品の買受"]
[{"$nulls":7},"118　　精密機器類",{"$nulls":40},"218　　精密機器類"]
[{"$nulls":7},"119　　医療用機器類",{"$nulls":40},"219　　医療用機器類"]
[{"$nulls":7},"120　　事務用機器類",{"$nulls":40},"220　　事務用機器類",{"$nulls":33},"営業品目",{"$nulls":6},"401　　立木竹"]
[{"$nulls":7},"121　　その他機器類",{"$nulls":40},"221　　その他機器類",{"$nulls":40},"402　　その他"]
[{"$nulls":7},"122　　医薬品・医療用品類",{"$nulls":40},"222　　医薬品・医療用品類"]
[{"$nulls":7},"123　　事務用品類",{"$nulls":40},"223　　事務用品類"]
[{"$nulls":7},"124　　土木・建設・建築材料",{"$nulls":40},"224　　土木・建設・建築材料"]
[{"$nulls":7},"126　　造幣・印刷事業用原材料類",{"$nulls":40},"226　　造幣・印刷事業用原材料類"]
[{"$nulls":7},"126　　造幣事業用金属工芸品類",{"$nulls":40},"226　　造幣事業用金属工芸品類",{"$nulls":32},"※その他、営業品目につき補足説明がある場合は記載してください。"]
[{"$nulls":7},"127　　警察用装備品類",{"$nulls":40},"227　　警察用装備品類"]
[{"$nulls":7},"128　　防衛用装備品類",{"$nulls":40},"228　　防衛用装備品類"]
[{"$nulls":7},"129　　その他",{"$nulls":40},"229　　その他"]

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[13,45,13,46]],"flags":["formulas_cached_only"]}
[{"$nulls":4},"※受付番号",{"$nulls":17},"※受付コード"]
[]
["営　　業　　所　　一　　覧　　表"]
[]
["番　号","営 業 所 名 称",{"$nulls":11},"郵 便\n\n番 号",null,null,null,"所　　　　　　　　在　　　　　　　　地",{"$nulls":33},"電話・FAX番号"]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[{"$nulls":16},"-"]
[]
[]
["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、常時契約を締結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。"]

{"sheet":"使用印鑑届","index":4,"n_rows":15,"n_cols":41,"rows_kept":15,"cut":false,"hidden":false,"merged":[[14,17,14,22],[0,10,0,34],[8,2,8,42],[12,17,12,22],[13,17,13,22]],"flags":["formulas_cached_only"]}
[{"$nulls":10},"使　用　印　鑑　届"]
[]
[]
[]
[{"$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"]

{"sheet":"委任状","index":5,"n_rows":33,"n_cols":27,"rows_kept":33,"cut":false,"hidden":false,"merged":[[21,6,21,9],[21,2,21,5],[22,6,22,9],[32,2,32,5],[27,2,28,5],[23,6,23,9],[24,6,24,9],[11,11,11,14],[14,1,14,27],[20,6,20,9],[1,4,1,23],[9,11,9,14],[10,11,10,14],[10,7,10,10]],"flags":["formulas_cached_only"]}
[]
[{"$nulls":4},"委　　任　　状"]
[]
[]
[]
[{"$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"]