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{"sheet":" 【コンサル】申請方法 ","index":0,"n_rows":64,"n_cols":17,"rows_kept":64,"cut":false,"hidden":false,"merged":[[37,6,38,10],[53,6,53,11],[25,6,25,10],[32,4,38,4],[32,5,38,5],[47,6,47,8],[49,6,49,10],[50,4,52,4],[50,5,52,5],[50,6,52,10],[33,2,33,3],[34,2,34,3],[35,2,35,3],[36,2,36,3],[37,2,38,3],[56,2,58,3],[50,3,52,3],[39,2,40,3],[43,2,52,2],[43,3,45,3],[56,4,58,4],[56,5,58,5],[56,6,56,10],[58,6,58,10],[63,1,63,11],[54,2,55,3],[54,4,55,4],[54,5,55,5],[54,6,55,11],[43,4,45,4],[43,5,45,5],[46,3,49,3],[46,4,49,4],[46,5,49,5],[43,6,43,10],[44,6,44,10],[39,4,40,4],[39,5,40,5],[39,6,40,10],[41,2,42,3],[41,4,42,4],[41,5,42,5],[41,6,42,10],[28,2,29,3],[28,4,29,4],[28,5,29,5],[28,6,29,10],[30,2,31,3],[30,4,31,4],[30,5,31,5],[30,6,31,10],[21,2,24,3],[21,4,24,4],[21,5,24,5],[21,6,22,10],[23,6,24,10],[26,2,27,3],[26,4,27,4],[26,5,27,5],[26,6,27,10],[25,2,25,3],[17,4,18,4],[17,5,18,5],[17,6,18,10],[19,2,20,3],[19,4,20,4],[19,5,20,5],[19,6,20,10],[17,2,18,3],[0,1,0,11],[2,2,11,10],[14,2,14,3],[14,6,14,10],[15,2,16,3],[15,4,16,4],[15,5,16,5]],"flags":["formulas_cached_only"]}
[null,"令和７・８・９年度　建設コンサルタント業務等入札（見積）参加資格審査申請要領"]
[]
[null,null,"　令和７・８・９年度において青木村が発注する建設コンサルタント業務等の競争入札（見積）に参加を希望する方は、下記により「入札参加資格審査申請書」を提出してください。\n（1）提出書類の内容を審査し、入札参加資格があると認められた者については、入札参加資格登録業者名簿に登載します。申請がない場合には原則的に入札（見積）指名はしませんのでご注意ください。\n（2）入札参加資格登録の有効期間は、令和７年４月1日から令和１０年３月31日までです。\n（3）村内事業者の方は村に関する公租公課金の完納が必須条件ですのであわせてご確認ください。\n　※詳しい内容説明や申請様式が必要な場合は財政係までご照会ください。"]
{"$rows_empty":10}
[null,"■提出書類一覧表"]
[null,null,"提出書類",null,"法人","個人","備　　　考",{"$nulls":9}," "]
[null,null," 1.入札参加資格審査申請書",null,"〇","〇","宛先は、「青木村長」とする"]
[{"$nulls":6},"実印又は取引使用印を押印（様式１）"]
[null,null," 2.委任状　　　　",null,"△","△","支店、営業所等に取引上の権限を委任する場合に提出してください。（任意様式可）"]
[]
[null,null," 3.誓約書　　　　　　　　",null,"〇","〇","本店で作成し、実印を押印したものを提出してください。"]
[]
[null,null," 4.社会保険等加入状況申出書\n※加入義務がない場合は、社会保険に加入義務がないことについての申出書）",null,"〇","〇","記入・押印のうえ提出してください。"]
[]
[{"$nulls":6},"※証明する書類を添付してください。"]
[]
[null,null," 5.営業所一覧　　",null,"△","△","（任意様式可）"]
[null,null," 6.経営規模等総括表",null,"〇","〇","直前2年の営業年度における契約実績等を記載してください。\n（任意様式可）"]
[]
[null,null," 7.業務経歴書　　",null,"〇","〇","直前1年の各営業年度における業務経歴書を希望の業種ごとに作成してください。\n※経営事項審査申請時の工事経歴書の写しでも構いません。（任意様式可）"]
[]
[null,null," 8.技術者経歴書（名簿）　",null,"〇","〇","法令上、専門資格を要する業務を希望する場合に提出してください。\n（任意様式可）"]
[]
[null,null," 9.登録証明書又は登録通知書（写し）",null,"△","△"]
[null,null,"　　①　測量　",null,null,null,"測量法に基づく測量業者の登録"]
[null,null,"　　②　建築士事務所",null,null,null,"建築士法に基づく建築士事務所の登録"]
[null,null,"　　③　建設コンサルタント",null,null,null,"建設コンサルタント登録規定に基づく登録"]
[null,null,"　　④　地質調査",null,null,null,"地質調査業者登録規定に基づく登録"]
[null,null,"　　⑤　補償コンサルタント",null,null,null,"補償コンサルタント登録規定に基づく登録・土地家屋調査士法に基づく土地家屋調査士の登録・不動産の鑑定評価に関する法律に基づく不動産鑑定業者の登録・司法書士法に基づく司法書士の登録"]
[]
[null,null,"10.登記簿謄本（写可）",null,"〇",null,"商業登記簿謄本（履歴事項全部証明書、現在事項全部証明書でも可）\n（発行日が3か月以内のもの）"]
[]
[null,null,"11.身分証明書（写可）",null,null,"〇","代表者本籍地の市村村長が発行する証明書"]
[]
[null,null,"12.納税証明書\n　　（写可）\n\n（発行日が3か月以内のもの）","国税","〇","〇","（法人事業者）法人税、消費税及び地方消費税"]
[{"$nulls":6},"（個人事業者）申告所得税及び復興特別所得税と消費税及び地方消費税"]
[{"$nulls":6},"　※本社所在地の税務署が発行する未納税額がないことの証明書"]
[null,null,null,"都道府県税","〇","〇","法人事業税（法人事業者）"]
[{"$nulls":6},"個人事業税（個人事業者）"]
[{"$nulls":6},"本社所在地の都道府県が発行する未納税額がないことの証明書"]
[{"$nulls":6},"※委任先を設ける場合は、委任先住所のもの（この場合委任先所在地のものだけで可）"]
[null,null,null,"村税","△","△","完納証明書　…村内業者は必須\n　※委任先の有無にかかわらず、青木村に納税義務がある場合も必要。　\n　※個人事業者にあっては、代表者の完納証明書"]
[]
[]
[null,null,"13.印鑑登録証明書（写可）",null,"〇","〇","法人の場合は法務局、個人の場合は市区村村で3か月以内に発行されたものを提出してください。"]
[null,null,"14.使用印鑑届",null,"△","△","入札契約時に実印以外の印鑑を使用する場合は提出してください。（任意様式）"]
[]
[null,null,"15.財務諸表（写可）",null,"〇","〇","直前1年の営業年度のものを提出してください。"]
[{"$nulls":6},"法人：貸借対照表、損益計算書及び利益処分又は損失処理に関する書類"]
[{"$nulls":6},"個人：貸借対照表、損益計算書"]
[]
[null,null,"※　〇は必ず提出　△は該当する場合のみ提出"]
[null,null,"※　1.3.4の提出書類は、村指定の様式で提出してください。"]
[]
[null,"クリアファイル（透明）に入れて提出してください"]

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["（様式１）"]
[]
["令和７・８・９年度建設コンサルタント業務等入札（見積）参加資格審査申請書"]
[]
[{"$nulls":18},"令和",null,null,"年",null,"月",null,"日"]
[null,"青木村長　　北村　政夫　様"]
[]
[null,null,"この申請書及び添付書類の記載事項は、事実と相違ないことを誓約します。"]
[]
[]
[null,"1　申請者（本社）"]
[null,null,"フリガナ"]
[null,null,"商号又は名称"]
[]
[null,null,"所在地",{"$nulls":4},"〒","　　　　-　"]
[]
[null,null,"代表者役職",{"$nulls":11},"氏名",{"$nulls":10},"実印"]
[]
[null,null,"電話番号",null,null,null,"（　　　）　　　－",{"$nulls":7},"FAX番号",null,null,null,"（　　　）　　　－"]
[]
[]
[null,"2　委任先"]
[null,null,"フリガナ"]
[null,null,"名称"]
[]
[null,null,"所在地",{"$nulls":4},"〒　　　－","　　　　-　"]
[]
[null,null,"代表者役職",{"$nulls":11},"氏名",{"$nulls":10},"印"]
[]
[null,null,"電話番号",null,null,null,"（　　　）　　　－",{"$nulls":7},"FAX番号",null,null,null,"（　　　）　　　－"]
[]
[]
[null,"3　申請書に関する問い合わせ先"]
[null,null,"担当者名",{"$nulls":11},"電話番号",null,null,null,"（　　　）　　　－"]
[]
[]
[null,"※　行政書士記入記入欄【行政書士が申請書類を作成した場合のみ記入】"]
[null,null,"行政書士事務所名",{"$nulls":11},"電話番号",null,null,null,"（　　　）　　　－"]
[]
[]
[]
[]
[]
[]
[null,"4　入札参加を希望する業種"]
[null,null,"入札参加を希望する業種に〇印、登録のあるものに〇印、実績、資格者数について記入してください。"]
[]
[null,null,"測量","区分",null,null,"参加\n希望",null,"登録",null,"年間平均業務実績（千円）",{"$nulls":5},"資格者数（人）"]
[{"$nulls":10},"（直前2年間の平均）",{"$nulls":5},"測量士",{"$nulls":4},"測量士補"]
[null,null,null,"測量"]
[]
[null,null,"建築コンサルタント","区分",null,null,"参加\n希望",null,"登録",null,"年間平均業務実績（千円）",{"$nulls":5},"資格者数（人）"]
[{"$nulls":10},"（直前2年間の平均）"]
[null,null,null,"建築\nコンサルタント",{"$nulls":12},"一級建築士",null,null,"構造設計一級建築士",null,null,null,"木造建築史"]
[]
[{"$nulls":16},"二級建築士",null,null,"設備設計一級建築士",null,null,null,"建築設備士"]
[]
[]
[null,null,"建設コンサルタント","区分",null,null,"参加\n希望",null,"登録",null,"年間平均業務実績（千円）\n（直前2年間の平均）",{"$nulls":5},"資格者数（人）"]
[{"$nulls":16},"技術士",null,"RCCM",null,"認定技術\n管理者",null,"一級建築士免許取得者で\n5年以上の実務経験者"]
[]
[null,null,null,"河川砂防及び海岸・海洋"]
[null,null,null,"港湾及び空港"]
[null,null,null,"電力土木"]
[null,null,null,"道路"]
[null,null,null,"鉄道"]
[null,null,null,"上水道及び工業用水道"]
[null,null,null,"下水道"]
[null,null,null,"農業土木"]
[null,null,null,"森林土木"]
[null,null,null,"水産土木"]
[null,null,null,"廃棄物"]
[null,null,null,"造園"]
[null,null,null,"都市計画及び地方計画"]
[null,null,null,"地質"]
[null,null,null,"土質及び基礎"]
[null,null,null,"鋼構造及びコンクリート"]
[null,null,null,"トンネル"]
[null,null,null,"施工計画・施工設備"]
[null,null,null,"建設環境"]
[null,null,null,"機械"]
[null,null,null,"電気電子"]
[]
[]
[]
[null,null,"地質調査","区分",null,null,"参加\n希望",null,"登録",null,"年間平均業務実績（千円）\n（直前2年間の平均）",{"$nulls":5},"資格者数（人）"]
[{"$nulls":16},"技術士",null,"RCCM",null,"地質調査技士",null,null,"登録規定による登録の要件として認められた15年以上の実務経験者"]
[]
[null,null,null,"地質調査"]
[]
[null,null,"補償コンサルタント","区分",null,null,"参加\n希望",null,"登録",null,"年間平均業務実績（千円）\n（直前2年間の平均）",{"$nulls":5},"資格者数（人）"]
[{"$nulls":16},"補償業務管理士",null,null,null,"管理士以外で登録規定による登録の要件として認められた補償業務に関して7年以上の実務経験者もしくは補償業務管理者"]
[]
[]
[null,null,null,"土地調査"]
[null,null,null,"土地評価"]
[null,null,null,"物件"]
[null,null,null,"機械工作物"]
[null,null,null,"営業補償・特殊補償"]
[null,null,null,"事業損失"]
[null,null,null,"補償関連"]
[null,null,null,"総合補償"]
[]
[null,null,"※測量については、測量法第55条の第1項の登録が必要です。"]
[null,null,"※建築コンサルタントについては、建築士法第23条の登録が必要です。"]
[null,null,"※建設コンサルタント、地質調査、補償コンサルタントについては、それぞれの登録規定による登録がなくても入札参加を希望することができます。"]
[]
[]
[null,"5　会社概要"]
[null,null,"全従業員数",null,null,null,"人　",{"$nulls":7},"うち技術職員数",null,null,null,"人　"]
[]
[null,null,"委任先従業員数",null,null,null,"人　",{"$nulls":7},"うち技術職員数",null,null,null,"人　"]
[]
[]
[null,null,"営業年数",null,null,null,"年　"]

{"sheet":"★【コンサル】様式6（委任状）","index":2,"n_rows":29,"n_cols":16,"rows_kept":29,"cut":false,"hidden":false,"merged":[[24,6,24,12],[25,6,25,12],[5,1,5,6],[26,6,26,12],[27,6,27,12],[28,6,28,12],[1,1,1,15],[2,5,2,12],[8,7,8,9],[9,7,9,9],[16,3,16,5],[7,5,7,6],[12,1,12,15],[14,0,14,15]],"flags":["formulas_cached_only"]}
["（様式6）"]
[null,"委　　　任　　　状"]
[]
[{"$nulls":10},"令和　　　年　　　月　　　日"]
[]
[null,"青木村長　北村　政夫　様"]
[]
[{"$nulls":5},"委任者",null,"所在地",null,"〒"]
[{"$nulls":7},"商号又は名称"]
[{"$nulls":7},"代表者職氏名",{"$nulls":7},"実印"]
[]
[]
[null,"　私は、令和７・８・９年度の認定期間において、下記の者を代理人と定め下記事項に関する権限を委任します。"]
[]
["記"]
[]
[null,null,null,"受任者",null,null,"所在地",null,"〒"]
[{"$nulls":6},"商号又は名称"]
[{"$nulls":6},"代表者職氏名"]
[{"$nulls":6},"代表者職氏名",{"$nulls":8},"㊞"]
[{"$nulls":6},"電話番号"]
[{"$nulls":6},"ＦＡＸ番号"]
[]
[]
[null,null,"委任する事項",null,null,"１","入札・見積に関すること"]
[{"$nulls":5},"２","契約の締結に関すること"]
[{"$nulls":5},"３","物品の収受に関すること"]
[{"$nulls":5},"４","代金の請求及び受領に関すること"]
[{"$nulls":5},"５","復代理人選任に関すること"]

{"sheet":"★【コンサル】様式4（営業所一覧表）","index":3,"n_rows":16,"n_cols":4,"rows_kept":16,"cut":false,"hidden":false,"merged":[[6,0,11,0],[12,0,12,1],[1,0,1,3]],"flags":["formulas_cached_only"]}
[null,"（様式第4）",null,"（用紙Ａ４）"]
["営業所一覧表"]
[]
["区分","営業所名称","所在地","電話番号・FAX番号"]
["本社（社）",null,"〒\n"]
["主たる営業所（委任先）",null,"〒\n"]
["従たる営業所（委任先以外）",null,"〒\n"]
[null,null,"〒\n"]
[null,null,"〒\n"]
[null,null,"〒\n"]
[null,null,"〒\n"]
[null,null,"〒\n"]
["（記載要領）"]
[1,"本店（社）の欄は必ず記入してください。"]
[2,"委任先を設けている場合は、主たる営業所欄に記入してください。"]
[3,"委任先以外の営業所は従たる営業所の欄に記載してください（営業所が多数ある場合は、代表的な営業所のみの記入で構いません）。"]

{"sheet":"★【コンサル】様式5（経営規模等総括表）","index":4,"n_rows":37,"n_cols":7,"rows_kept":37,"cut":false,"hidden":false,"merged":[[1,0,1,6],[3,1,3,6],[9,2,9,5],[9,1,12,1],[23,5,23,6],[24,5,24,6],[4,0,8,0],[9,0,17,0],[18,0,22,0],[23,0,24,0],[9,6,12,6],[10,2,10,3],[10,4,10,5],[23,2,23,3],[4,5,4,6],[5,5,5,6],[6,5,6,6],[7,5,7,6],[8,5,8,6]],"flags":["formulas_cached_only"]}
["（様式第5）",{"$nulls":5},"（用紙Ａ４）"]
["経営規模等総括表"]
[]
["商号又は名称"]
["登録番号及び登録年月日","測量","第",null,"号","年　　　　月　　　　日"]
[null,"　  　 級建築士事務所","第",null,"号","年　　　　月　　　　日"]
[null,"建設コンサルタント登録","第",null,"号","年　　　　月　　　　日"]
[null,"地質調査業務登録","第",null,"号","年　　　　月　　　　日"]
[null,"補償コンサルタント登録","第",null,"号","年　　　　月　　　　日"]
["契約実績高","　競争入札に参加を希望する\n　業種区分","直前2年の各営業年度の決算に基づく契約金額",null,null,null,"直前2年間の\n年平均実績高"]
[null,null,"前前年の営業年度",null,"直前の営業年度"]
[null,null,"自　　年　　月","自　　年　　月","自　　年　　月","自　　年　　月"]
[null,null,"至　　年　　月","至　　年　　月","至　　年　　月","至　　年　　月"]
[null,"測量","千円","千円","千円","千円","千円"]
[null,"建築設計","千円","千円","千円","千円","千円"]
[null,"建設コンサルタント","千円","千円","千円","千円","千円"]
[null,"地質調査","千円","千円","千円","千円","千円"]
[null,"補償算定","千円","千円","千円","千円","千円"]
["自己資本額","区分","直前決算時","剰余（欠損）金処分","計","決算後の増減額","合計"]
[null,"払込資本額","千円",null,"千円",null,"千円"]
[null,"積立金","千円","千円","千円",null,"千円"]
[null,"繰越（欠損）金",null,"千円","千円",null,"千円"]
[null,"計","千円","千円","千円",null,"千円"]
["営業年数","創業","転廃業（休業）",null,"現組織への変更","営業年数"]
[null,"年　　月　　日　","　自　　　年　　　月　","　至　　　年　　　月　","　　　年　　　月　","　　　　　　　　年　　　　"]
{"$rows_empty":11}
[{"$nulls":5},"　"]

{"sheet":"★【コンサル】様式3（業務経歴書）","index":5,"n_rows":30,"n_cols":15,"rows_kept":30,"cut":false,"hidden":false,"merged":[[4,1,5,2],[4,4,5,6],[4,8,5,9],[4,10,4,12],[4,13,5,13],[6,8,6,9],[7,8,7,9],[8,8,8,9],[20,8,20,9],[9,8,9,9],[10,8,10,9],[11,8,11,9],[12,8,12,9],[13,8,13,9],[14,8,14,9],[21,8,21,9],[22,8,22,9],[23,8,23,9],[24,8,24,9],[25,8,25,9],[15,8,15,9],[16,8,16,9],[17,8,17,9],[18,8,18,9],[19,8,19,9]],"flags":["formulas_cached_only"]}
["（様式第３）",{"$nulls":13},"（用紙Ａ４）"]
[null,null,null,"業　　務　　経　　歴　　書"]
[]
[null,"（業種名：　　　　　　　）（業務：　　　　　　　　）"]
[null,"注文者",null,"元負又は","件名",null,null,"業務履行場所","測量等の対象の規模",null,"請負代金の額",null,null,"着工年月","完成又は　　"]
[null,null,null,"下請の別",null,null,null,"の県市町村名",null,null,null,"（千円）",null,null,"完成予定年月"]
{"$rows_empty":20}
[null,"（記載要領）"]
[null,1,"この表は業種（測量・建築コンサルタント・地質調査・補償コンサルタントの５種類ごとに作成してください。"]
[null,2,"建設コンサルタントに会っては、希望業種内容（申請書面上に記載されている詳細を参照）ごとに作成してください。"]
[null,3,"請負代金の額は消費税込みの額を記載してください。"]

{"sheet":"★【コンサル】様式2（技術者経歴書）","index":6,"n_rows":31,"n_cols":14,"rows_kept":31,"cut":false,"hidden":false,"merged":[[4,12,4,13],[5,1,5,2],[4,1,4,2],[4,3,5,3],[4,4,4,6],[4,7,4,8],[4,9,5,10],[4,11,5,11]],"flags":["formulas_cached_only"]}
["（様式第２号）",{"$nulls":12},"（用紙Ａ４）"]
[null,null,null,"技　術　者　経　歴　書"]
[]
[null,null,"（業務名：　　　　　　　　　　)"]
[null,"氏　　名",null,"年齢","法令による免許等",null,null,"技術修得課程",null,"実務経歴",null,"経　験　　　年月数","技術者該当区分(○印)"]
[null,"（生年月日）",null,null,"有資格名称","取得年月","交付番号等","学校名","専攻学科",null,null,null,"主任技術者","管理技術者"]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[{"$nulls":11},"　年　月"]
[]
[null,"（記載要領）"]
[null,null,"※実際に雇用している資格者について、すべての資格を記載してください。"]
[null,null,"※雇用保険料等の納付状況が確認できる書類(写し可）を添付してください。"]
[null,null,"※会社として所有する許認可資格等についても適宜記載してください。"]
[null,null,"※実務経験により「主任技術者」の要件を有する者などについても適宜記載してください。"]