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{"sheet":"様式1～5","index":0,"n_rows":907,"n_cols":30,"rows_kept":907,"cut":false,"hidden":false,"merged":[[168,19,168,21],[168,22,168,25],[160,19,160,21],[160,22,160,25],[161,19,161,21],[162,19,162,21],[163,19,163,21],[164,19,164,21],[165,19,165,21],[166,19,166,21],[167,19,167,21],[161,22,161,25],[162,22,162,25],[163,22,163,25],[164,22,164,25],[165,22,165,25],[166,22,166,25],[167,22,167,25],[0,0,0,3],[50,0,50,3],[98,0,98,3],[151,0,151,3],[199,0,199,3],[206,2,206,6],[187,10,187,13],[188,10,188,13],[201,0,201,25],[107,1,107,4],[121,0,121,25],[18,1,20,24],[21,1,23,24],[136,1,138,24],[129,1,129,8],[158,2,158,7],[24,0,24,25],[58,1,59,11],[60,1,61,11],[62,1,63,11],[58,12,59,24],[60,12,61,24],[62,12,63,24],[57,1,57,11],[382,1,383,25],[387,0,387,25],[307,0,311,0],[317,0,317,25],[331,1,332,25],[336,0,336,25],[363,19,363,25],[364,19,364,25],[231,9,231,13],[232,9,232,13],[378,0,378,25],[261,0,265,0],[216,0,217,25],[230,9,230,13],[166,1,166,6],[166,7,166,13],[68,1,68,2],[124,9,124,24],[125,9,125,24],[126,9,128,24],[129,9,129,24],[130,9,130,24],[115,1,117,24],[123,9,123,24],[70,1,70,2],[101,0,101,25],[105,1,105,4],[106,1,106,4],[164,1,164,6],[123,1,123,8],[152,0,152,25],[124,1,124,8],[125,1,125,8],[133,1,135,24],[160,1,160,6],[155,2,155,6],[65,3,66,24],[65,1,65,2],[57,12,57,24],[126,1,128,8],[130,1,130,8],[4,0,4,25],[14,11,14,14],[15,11,15,14],[16,11,16,14],[52,0,53,25],[30,2,30,19],[186,10,186,13],[185,10,185,13],[171,1,176,25],[161,7,161,13],[161,14,161,16],[163,1,163,6],[163,7,163,13],[163,14,163,16],[165,1,165,6],[165,7,165,13],[165,14,165,16],[162,1,162,6],[162,7,162,13],[162,14,162,16],[161,1,161,6],[161,17,161,18],[162,17,162,18],[163,17,163,18],[164,17,164,18],[165,17,165,18],[166,17,166,18],[167,17,167,18],[169,19,169,21],[169,22,169,25],[160,7,160,13],[167,1,167,6],[167,7,167,13],[169,1,169,6],[169,7,169,13],[169,14,169,16],[166,14,166,16],[164,7,164,13],[164,14,164,16],[167,14,167,16],[160,14,160,18],[168,1,168,6],[169,17,169,18],[168,7,168,13],[168,17,168,18],[168,14,168,16]]}
["様式　１"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(用紙A4判)"]
[]
[]
["競争参加資格確認申請書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"$AF$182","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和○○年○○月○○日"]
[]
[]
[null,"分任支出負担行為担当官"]
[null,null,null,"飛騨森林管理署長　辻井　正徳　殿"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"住　　　　所"]
[null,null,null,null,null,null,null,null,null,null,null,"商号又は名称"]
[null,null,null,null,null,null,null,null,null,null,null,"代表者氏名"]
[]
[null,"令和８年３月２５日付けで入札公告のありました久々野地区建設機械借上に係る競争参加資格について確認されたく、下記の書類を添えて申請します。"]
[]
[]
[null,"　なお、予算決算及び会計令(昭和22年勅令165号)第70条及び71条の規定に該当する者でないこと及び添付書類内容については事実と相違ないことを誓約する。"]
[]
[]
["記"]
[]
[]
[]
[]
[]
[null,1,"．入札説明書５の(4)の①及び②に定める資格確認表"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"（印鑑省略時記載）"]
[null,null,null,null,null,null,null,null,null,null,"会社名及び部署名：",null,null,null,null,null,"　"]
[null,null,null,null,null,null,null,null,null,null,"本件責任者(氏名)："]
[null,null,null,null,null,null,null,null,null,null,"担  当  者(氏名)："]
[null,null,null,null,null,null,null,null,null,null,"連 絡 先１："]
[null,null,null,null,null,null,null,null,null,null,"連 絡 先２："]
[]
[]
[]
[]
[]
["様式　２"]
[]
[" 資　格　確　認　表"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"会社名：○○○○"]
[]
[null,"項　　　　　目"]
[null,"「役務の提供等」の全省庁統一資格"]
[]
[null,"「建設工事」の中部森林管理局競争参加資格"]
[]
[null,"配置予定建設機械運転有資格者の氏名（複数でも可）\n"]
[]
[]
[null,"注１）",null," 「役務の提供等」の全省庁統一資格又は「建設工事」の中部森林管理局競争参加資格のどちらか一方を選択すること。"]
[]
[]
[null,"注２）",null," 記載した通知書の写しを添付すること。"]
[]
[null,"注３）",null,"配置予定建設機械運転有資格者の当該資格の免許証等の写しを添付すること。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["様式　３"]
[]
[]
["競争参加資格確認通知書"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和○○年○○月○○日"]
[null,"住所"]
[null,"商号又は名称"]
[null,"代表者氏名",null,null,null,null,null,null,null,"殿"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"分任支出負担行為担当官"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"飛騨森林管理署長　辻井　正徳"]
[]
[]
[]
[null,"先に申請のあった久々野地区建設機械借上に係る競争参加資格については、下記のとおり確認したので通知します。"]
[]
[]
[]
[]
[]
["記"]
[]
[null,"　入札公告日",null,null,null,null,null,null,null,"　令和○○年○○月○○日"]
[null,"　作　業　名",null,null,null,null,null,null,null,"久々野地区建設機械借上"]
[null,"　競争参加資格の有無",null,null,null,null,null,null,null,"　有　　無"]
[null,"　競争参加資格がないと\n　認めた理由"]
[]
[]
[null,"　変更入札日時",null,null,null,null,null,null,null,"　令和○○年○○月○○日　○○時○○分"]
[null,"　変更開札日時",null,null,null,null,null,null,null,"　令和○○年○○月○○日　○○時○○分"]
[]
[]
[null,"　競争参加資格がないと通知された方は、競争参加資格がないと認めた理由について、説明を求めることができます。"]
[]
[]
[null,"　この説明を求める場合は、本通知日の翌日から起算して７日（休日は含めない。）以内に総務グループへその旨を記載した書面を提出して下さい。"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　【担　当】"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"業務グループ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"森林整備官　〇〇　〇〇"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL：050-3160-6085"]
[]
[]
[]
["様式　４"]
["入 札 書 (見 積 書)"]
[]
[]
[null,1,".作業名",null,null,null,null,"：","久々野地区建設機械借上"]
[]
[]
[null,2,".入札(見積)単価"]
[]
[null,"機　　　種",null,null,null,null,null,"規　　　格",null,null,null,null,null,null,"数量",null,null,null,null,"単価",null,null,"金額"]
[null,"ﾊﾞｯｸﾎｳ",null,null,null,null,null,"山積0.28m3[平積0.20m3]",null,null,null,null,null,null,200,null,null,"h"]
[null,"ﾀﾞﾝﾌﾟﾄﾗｯｸ",null,null,null,null,null,"4t積 (普通)",null,null,null,null,null,null,75,null,null,"h"]
[null,"補助労務",null,null,null,null,null,"軽作業員",null,null,null,null,null,null,200,null,null,"h"]
[null,"重機運搬車",null,null,null,null,null,"0.28m3級（10t以下）0.1～10.0kmまで",null,null,null,null,null,null,2,null,null,"回"]
[null,"重機運搬車",null,null,null,null,null,"0.28m3級（10t以下）10.1～20.0kmまで",null,null,null,null,null,null,5,null,null,"回"]
[null,"重機運搬車",null,null,null,null,null,"0.28m3級（10t以下）20.1～30.0kmまで",null,null,null,null,null,null,4,null,null,"回"]
[null,"重機運搬車",null,null,null,null,null,"0.28m3級（10t以下）30.1～40.0kmまで",null,null,null,null,null,null,2,null,null,"回"]
[null,"重機運搬車",null,null,null,null,null,"0.28m3級（10t以下）40.1～50.0kmまで",null,null,null,null,null,null,2,null,null,"回"]
[null,"計"]
[]
[null,"　上記単価には間接経費を含んでいます。また、上記金額は消費税相当額を除いた金額ですので、契約金額は上記金額に10％に相当する額を加算した金額となること、また、入札心得、契約書(案)承諾の上で入札(見積)します。"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和○○年○○月○○日"]
[]
[null,"分任支出負担行為担当官"]
[null,null,{"$f":"C12","v":0},"飛騨森林管理署長　辻井　正徳　殿"]
[null,null,{"$f":"C13","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,null,null,null,null,null,null,null,null,"会社名"]
[null,null,null,null,null,null,null,null,null,null,"代表者氏名"]
[null,null,null,null,null,null,null,null,null,null,"代理人"]
[]
[null,null,null,null,null,null,null,null,null,null,"（印鑑省略時記載）"]
[null,null,null,null,null,null,null,null,null,null,"会社名及び部署名：",null,null,null,null,null,"　"]
[null,null,null,null,null,null,null,null,null,null,"本件責任者(氏名)："]
[null,null,null,null,null,null,null,null,null,null,"担  当  者(氏名)："]
[null,null,null,null,null,null,null,null,null,null,"連 絡 先１："]
[null,null,null,null,null,null,null,null,null,null,"連 絡 先２："]
[]
[]
[]
["様式　５"]
[]
["委　　任　　状"]
[]
[]
[]
[]
[null,null,"代理人氏名"]
[]
[]
[]
[]
[]
[]
[null,null,"上記の者を代理人と定め、下記の権限を委任します。"]
[]
[]
["記"]
[]
[]
[]
[null,null,1,null,"入札年月日"]
[]
[null,null,2,null,"件名"]
[]
[null,null,3,null,"入札に関する一切の件"]
[]
[]
[]
[null,null,null,"令和○○年○○月○○日"]
[]
[null,null,null,null,null,null,null,null,null,"住所"]
[null,null,null,null,null,null,null,null,null,"商号又は名称"]
[null,null,null,null,null,null,null,null,null,"代表者氏名"]
[]
[]
[]
[null,"分任支出負担行為担当官"]
[null,null,{"$f":"C183","v":0},"飛騨森林管理署長　辻井　正徳　殿"]
[null,null,{"$f":"C184","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,"（印鑑省略時記載）"]
[null,null,null,null,null,null,null,null,null,null,"会社名及び部署名：",null,null,null,null,null,"　"]
[null,null,null,null,null,null,null,null,null,null,"本件責任者(氏名)："]
[null,null,null,null,null,null,null,null,null,null,"担  当  者(氏名)："]
[null,null,null,null,null,null,null,null,null,null,"連 絡 先１："]
[null,null,null,null,null,null,null,null,null,null,"連 絡 先２："]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]

{"sheet":"様-6暴力団排除の誓約","index":1,"n_rows":42,"n_cols":6,"rows_kept":42,"cut":false,"hidden":false,"merged":[[3,0,3,8],[6,1,11,8],[16,1,20,8],[22,1,23,8],[28,1,28,8],[25,1,26,8]]}
["様式６"]
[]
[]
["暴力団排除に関する誓約書"]
[]
[]
[null,"　当社（個人である場合は私、団体である場合は当団体）は、下記１及び２のいずれにも該当せず、また、将来においても該当しないことを誓約します。\nこの誓約が虚偽であり、又はこの誓約に反したことにより、当方が不利益を被ることとなっても、異議は一切申し立てません。\n　また、貴省の求めに応じ、当方の役員名簿(有価証券報告書に記載のもの。ただし、有価証券報告書を作成していない場合は、役職名、氏名及び生年月日の一覧表)を警察に提供することについて同意します。"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,"記"]
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["　　１　契約の相手方として不適当な者"]
[-1,"　法人等（個人、法人又は団体をいう。）の役員等（個人である場合はその者、法人である場合は役員又は支店若しくは営業所（常時契約を締結する事務所をいう。）の代表者、団体である場合は代表者、理事等、その他経営に実質的に関与している者をいう。）が、暴力団（暴力団員による不当な行為の防止等に関する法律（平成３年法律第77号）第２条第２号に規定する暴力団をいう。以下同じ。）又は暴力団員（同法第２条第６号に規定する暴力団員をいう。以下同じ。）であるとき"]
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[{"$f":"A17-1","v":-2},"　役員等が、自己、自社若しくは第三者の不正の利益を図る目的、又は第三者に損害を加える目的をもって、暴力団又は暴力団員を利用するなどしているとき"]
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[{"$f":"A23-1","v":-3},"　役員等が、暴力団又は暴力団員に対して、資金等を供給し、又は便宜を供与するなど直接的あるいは積極的に暴力団の維持、運営に協力し、若しくは関与しているとき"]
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[{"$f":"A26-1","v":-4},"役員等が、暴力団又は暴力団員であることを知りながらこれを利用するなどしているとき"]
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[{"$f":"A29-1","v":-5},"　役員等が、暴力団又は暴力団員と社会的に非難されるべき関係を有しているとき"]
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["２　契約の相手方として不適当な行為をする者"]
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[-1,"　暴力的な要求行為を行う者"]
[{"$f":"A35-1","v":-2},"　法的な責任を超えた不当な要求行為を行う者"]
[{"$f":"A36-1","v":-3},"　取引に関して脅迫的な言動をし、又は暴力を用いる行為を行う者"]
[-4,"　偽計又は威力を用いて契約担当官等の業務を妨害する行為を行う者"]
[-5,"　その他前各号に準ずる行為を行う者"]
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["  上記事項について、入札書の提出をもって誓約します。"]