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[null,null,"〔様式－１〕"]
[]
[null,"基 本 協 定 締 結 参 加 申 請 書"]
[]
[]
[null,null,null,null,null,null,null,"令和　　　　年　　　　月　　　　日"]
[]
[null,null,"国土交通省　九州地方整備局"]
[null,null,"九州技術事務所長"]
[null,null,"　　　　　　　　　　","山下　尚　　殿"]
[]
[]
[null,null,null,null,"住所",null,"〒"]
[]
[null,null,null,null,"会社名　"]
[null,null,null,null,"代表者"]
[]
[]
[]
[]
[null,null,"　令和６年１月２６日付けで公告がありました、「災害時における災害対策用機械の出動等に関する基本協定の締結」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,null,"　なお、下記１～８に掲げる添付資料及び９に掲げる事項については、事実と相違ないことを誓約いたします。"]
[]
[null,null,"記"]
[]
[null,null,"１．","技術資料等説明書　９．（２）","に定める協定を希望する九州技術事務所が保有する災対機械等を記載した書面",null,null,null,null,"［様式－２］"]
[null,null,"２．","技術資料等説明書　９．（３）","に定める工事、業務、役務の提供等における施工実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"３．","技術資料等説明書　９．（４）","に定める災害時における災対機械等の出動作業の実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"４．","技術資料等説明書　９．（５）","に定める応急復旧工事等の実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"５．","技術資料等説明書　９．（６）","に定める協定締結実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"６．","技術資料等説明書　９．（７）","に定める災対機械等の製造、保守点検又は修繕実績を記載した書面　",null,null,null,null,"［様式－３］"]
[null,null,"７．","技術資料等説明書　９．（８）","に定める派遣作業員数及び資格保有者状況を記載した書面　",null,null,null,null,"［様式－４］"]
[null,null,"８．","技術資料等説明書　９．（９）","に定める派遣作業員の所属する部署の所在地を記載した書面　",null,null,null,null,"［様式－４］"]
[null,null,"９．","技術資料等説明書  ４．（１）","に定める条件を満たしていること"]
[null,null,"10．","問い合わせ先","担当者","："]
[null,null,null,null,"部署","："]
[null,null,null,null,"役職","："]
[null,null,null,null,"電話番号","："]
[null,null,null,null,"FAX","："]
[null,null,null,null,"E-mail","："]

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["〔様式－２〕",null,"会社名　："]
[]
["９．（２）協定を希望する九州技術事務所が保有又は保管する災対機械等"]
["①協定を希望する九州技術事務所が保有又は保管する災対機械等について、表の「協定希望」の欄に○印を記入して下さい。"]
["②協定を希望する災対機械等の「協定希望作業内容」を○で囲んで下さい。"]
["③複数の災対機械、作業内容を希望することが出来ます。"]
["機械等名",null,"台数","協 定\n希 望","作業内容","備考"]
["災対機械等","対策本部車",1,null,"運搬　・　設置撤去","自走 10,400kg"]
[]
[null,"待機支援車",2,null,"運搬　・　設置撤去","①自走 5,180kg（バス型）"]
[null,null,null,null,null,"②自走 3,380kg（小型）"]
[null,"照明車",4,null,"運搬　・　設置撤去　・　操作","①自走 7,470kg（カメラ付き）"]
[null,null,null,null,null,"②自走 7.600kg（カメラ付き）"]
[null,null,null,null,null,"③自走 7.630kg（カメラ付き）"]
[null,null,null,null,null,"④自走 7,480kg（カメラ付き）"]
[null,"排水ポンプ車",3,null,"運搬　・　設置撤去　・　操作","①自走 18,260kg （60m3/min)"]
[null,null,null,null,null,"②自走 18,260kg （60m3/min)"]
[null,null,null,null,null,"③自走 9,140kg （30m3/min)"]
[null,"バックホウ",2,null,"運搬　・　操作","①0.45m3級"]
[null,null,null,null,null,"②0.8m3級　遠隔操縦式"]
[null,"分解組立型バックホウ",1,null,"運搬　・　分解組立　・　操作","機械総質量　約 25,000kg\n１ﾌﾞﾛｯｸ 2,800kg以下"]
[]
[null,"簡易遠隔操縦装置",2,null,"運搬　・　設置撤去　・　操作","①ﾊﾞｯｸﾎｳ用　75kg"]
[null,null,null,null,null,"②ﾊﾞｯｸﾎｳ用　75kg"]
[null,"応急組立橋",2,null,"運搬　・　架設　・　撤収","①支間長 30m/架設質量53.8t"]
[null,null,null,null,null,"②支間長 40m/架設質量120.5t"]
[null,"不整地運搬車",1,null,"運搬　・　操作","3,110kg"]
[]
[null,"災害対策用照明装置",1,null,"運搬　・　設置撤去　・　操作","1,295kg"]
[]
[null,"橋梁点検車",1,null,"運搬　・　操作","自走 24,940ｋｇ"]
[]
[null,"作業車",1,null,"運搬　・　操作","自走 7,990kg"]
[]
[null,"散水車",1,null,"運搬　・　操作","自走 12,200kg"]
[]
[null,"資機材等","－",null,"運搬　・　設置撤去　・　操作","①クレーン吊上 移動装置\n②フォークリフト移動装置\n③人力移動装置\n④大型土嚢、大型土嚢袋詰機\n⑤ジャッキ付コンテナ\n⑥可搬式遠隔操作室\n⑦つかみ装置\n⑧油圧ブレーカ等"]
[null,null,null,null,null,"自走車の質量：車両総質量"]
["※１","実際に行う作業内容については、要請事務所等との契約時に決定します。"]
[null,"※運搬とは、災対機械等の保管場所から出動場所までの間の出動又は返納に要する作業である。"]
[null,"※設置撤去、分解組立とは、機械が稼働（操作）できる状態又は撤収できる状態までに要する作業である。"]
[null,"※操作とは、機械の稼働・停止に係る作業である。"]
[null,"※架設・撤収とは、応急組立橋を架設する作業、応急組立橋を返納時に運搬できる状態までに要する作業である。"]

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[null,"〔様式－３〕",null,"会社名　："]
[]
[null,"９．（３）工事、業務、役務の提供等の施工実績　（１件記載）"]
[null,"施工実績","契約等件名"]
[null,null,"契約の相手方"]
[null,null,null,"担当部署　："]
[null,null,null,"機関の別　："]
[null,null,"契約期間"]
[null,null,"契約内容の概要"]
[]
[null,"９．（４）災害時における出動作業の実績　（１件記載）"]
[null,"出動作業実績","契約等件名"]
[null,null,"協定の相手方"]
[null,null,null,"担当部署　："]
[null,null,null,"機関の別　："]
[null,null,"作業日（期間）"]
[null,null,"出動した災対機械等"]
[null,null,"出動した災対機械等保有機関名"]
[]
[null,"９．（５）災害時における応急復旧工事、応急対策業務等の実績　（１件記載）"]
[null,"災害対応作業実績","契約等件名"]
[null,null,"協定の相手方"]
[null,null,null,"担当部署　："]
[null,null,null,"機関の別　："]
[null,null,"作業日（期間）"]
[null,null,"災害対応作業の内容"]
[]
[null,"９．（６）災害時における上記（４）又は（５）に関わる協定締結実績　（１件記載）"]
[null,"協定締結実績","協定等名"]
[null,null,"協定の相手方"]
[null,null,null,"機関の別　："]
[null,null,"協定期間"]
[null,null,"協定の内容及び\n協定対象機械名等"]
[null,null,null,"　内容　：　"]
[]
[null,"９．（７）災対機械等の製造、保守点検又は修繕実績　（１件記載）"]
[null,"保守点検実績","契約等件名"]
[null,null,"契約の相手方"]
[null,null,null,"担当部署　："]
[null,null,null,"機関の別　："]
[null,null,"契約期間"]
[null,null,"対象となる災対機械名等"]
[]
[null,"※","記載にあたっての留意点は、以下のとおりです。"]
[]
[null,"１．","契約の実績がわかるものの写しを添付して下さい。（記入内容が判明するページのみで可）"]
[null,"２．","施工実績、出動作業、応急復旧工事等の実績が判断できる資料（契約書、災害時における出動等要請書、協議書等）の写し、協定書の写しおよび対象機械等が判る資料の写しを添付して下さい。（記入内容が判明するページのみで可）"]
[null,"３．","契約等件名や協定等件名は、正式な件名を記入して下さい。"]
[null,"４．","契約や協定の相手方は、正式名称を記入して下さい。"]
[null,"５．","出動作業、協定、保守点検の対象となる災対機械等が多数の場合は、代表的なものを「１～２機種」記入して下さい。"]

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[]
[null,"〔様式－４〕",null,null,"会社名　："]
[]
[null,"９．（８）派遣作業員数及び資格保有者状況"]
[null,"　　①本協定に従事する作業員数"]
[null,null,null,null,"従事する作業員数",null,null,null,"人"]
[]
[null,null,"②本協定に従事する作業員の資格保有者状況"]
[null,"区分",null,"免許・資格等名",null,"資格保有者状況",null,null,null,null,null,null,null,null,"一級・二級\n土木施工管理技士"]
[null,null,null,null,null,"いる","人数",null,"いない",null,null,null,null,null,"大型自動車運転"]
[null,"免許・資格",null,"一級・二級\n土木施工管理技士",null,null,null,"人",null,null,null,null,null,null,"中型自動車運転"]
[null,null,null,"大型自動車運転",null,null,null,"人",null,null,null,null,null,null,"中型自動車運転（８ｔ限定）"]
[null,null,null,"移動式クレーン運転",null,null,null,"人",null,null,null,null,null,null,"移動式クレーン運転"]
[null,"技能講習",null,"玉掛け",null,null,null,"人",null,null,null,null,null,null,"玉掛け"]
[null,null,null,"小型移動式クレーン運転",null,null,null,"人",null,null,null,null,null,null,"小型移動式クレーン運転"]
[null,null,null,"高所作業車運転・10ｍ以上",null,null,null,"人",null,null,null,null,null,null,"高所作業車運転・10ｍ以上"]
[null,null,null,"車両系建設機械運転（整地等）",null,null,null,"人",null,null,null,null,null,null,"車両系建設機械運転（整地等）"]
[null,null,null,"不整地運搬車運転",null,null,null,"人",null,null,null,null,null,null,"不整地運搬車運転"]
[]
[null,"※","各種免許・資格等の保有者で、当該協定に従事可能な資格保有者状況を「いる」「いない」欄のいずれかに丸印及び人数を記入して下さい。"]
[]
[null,"９．（９）派遣作業員の所属する部署の所在地"]
[null,"　　①派遣作業員の所属する部署の所在地"]
[null,null,"営業所－１",null,"名称　："]
[null,null,null,null,"住所　："]
[null,null,null,null,"九州技術事務所までの距離：",null,null,null,null,"㎞"]
[null,null,null,null,"　　　　　　〃　　　　　　時間：",null,null,"時間",null,"分"]
[]
[null,null,"営業所等－２　　",null,"名称　："]
[null,null,null,null,"住所　："]
[null,null,null,null,"九州技術事務所までの距離：",null,null,null,null,"㎞"]
[null,null,null,null,"　　　　　　〃　　　　　　時間：",null,null,"時間",null,"分"]
[null,null,"※ ・所属する部署が複数箇所存在する場合、九州技術事務所に近い順から２カ所を記載して下さい。\n　　・九州技術事務所までの距離は、一般道での距離を記載して下さい。\n　　・営業所から九州技術事務所までの距離が確認できる資料（地図等）を添付して下さい。\n　　"]

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[null,"(記入例）"]
[null,null,"〔様式－１〕 "]
[]
[null,"基 本 協 定 締 結 参 加 申 請 書"]
[]
[]
[null,null,null,null,null,null,null,"令和　　　　年　　　　月　　　　日"]
[]
[null,null,"国土交通省　九州地方整備局"]
[null,null,"九州技術事務所長"]
[null,null,"　　　　　　　　　　","山下　尚　　殿"]
[]
[]
[null,null,null,null,"住所",null,"〒000-0000"]
[null,null,null,null,null,null,"○○県○○市○○○○○○○"]
[null,null,null,null,"会社名　",null,"○○○○株式会社"]
[null,null,null,null,"代表者",null,"代表取締役　　建設　　太郎　　印"]
[]
[]
[]
[]
[null,null,"　令和○年○月○日付けで公告がありました、「災害時における災害対策用機械の出動等に関する基本協定の締結」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,null,"　なお、下記１～８に掲げる添付資料及び９に掲げる事項については、事実と相違ないことを誓約します。"]
[]
[null,null,"記"]
[]
[null,null,"１．","技術資料等説明書　９．（２）","に定める協定を希望する九州技術事務所が保有する災対機械等を記載した書面",null,null,null,null,"［様式－２］"]
[null,null,"２．","技術資料等説明書　９．（３）","に定める工事、業務、役務の提供等における施工実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"３．","技術資料等説明書　９．（４）","に定める災害時における災対機械等の出動作業の実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"４．","技術資料等説明書　９．（５）","に定める応急復旧工事等の実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"５．","技術資料等説明書　９．（６）","に定める協定締結実績を記載した書面",null,null,null,null,"［様式－３］"]
[null,null,"６．","技術資料等説明書　９．（７）","に定める災対機械等の製造、保守点検又は修繕実績を記載した書面　",null,null,null,null,"［様式－３］"]
[null,null,"７．","技術資料等説明書　９．（８）","に定める派遣作業員数及び資格保有者状況を記載した書面　",null,null,null,null,"［様式－４］"]
[null,null,"８．","技術資料等説明書　９．（９）","に定める派遣作業員の所属する部署の所在地を記載した書面　",null,null,null,null,"［様式－４］"]
[null,null,"９．","技術資料等説明書  ４．（１）","に定める条件を満たしていること"]
[null,null,"10．","問い合わせ先","担当者","：","建設　次郎"]
[null,null,null,null,"部署","：","○○部○○課"]
[null,null,null,null,"役職","：","○○課長"]
[null,null,null,null,"電話番号","：","０００－０００－００００（代）　　［内線００００］"]
[null,null,null,null,"FAX","：","０００－０００－００００"]
[null,null,null,null,"E-mail","：","abcdef@●●.▼.jp"]
[]
[null,null,null,null,"電話番号、FAX、E-mailの誤記には、\n十分ご注意くださいますよう、お願いいたします。"]

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["〔様式－２〕",null,"会社名　："]
[]
["９．（２）協定を希望する九州技術事務所が保有又は保管する災対機械等"]
["①協定を希望する九州技術事務所が保有又は保管する災対機械等について、表の「協定希望」の欄に○印を記入して下さい。"]
["②協定を希望する災対機械等の「協定希望作業内容」を○で囲んで下さい。"]
["③複数の災対機械、作業内容を希望することが出来ます。"]
["機械等名",null,"台数","協 定\n希 望","作業内容","備考"]
["災対機械等","対策本部車",1,"○","運搬　・　設置撤去","自走 10,400kg"]
[]
[null,"待機支援車",2,"○","運搬　・　設置撤去","①自走 5,180kg（バス型）"]
[null,null,null,null,null,"②自走 3,380kg（小型）"]
[null,"照明車",4,"○","運搬　・　設置撤去　・　操作","①自走 7,470kg（カメラ付き）"]
[null,null,null,null,null,"②自走 7.600kg（カメラ付き）"]
[null,null,null,null,null,"③自走 7.630kg（カメラ付き）"]
[null,null,null,null,null,"④自走 7,480kg（カメラ付き）"]
[null,"排水ポンプ車",3,"○","運搬　・　設置撤去　・　操作","①自走 18,260kg （60m3/min)"]
[null,null,null,null,null,"②自走 18,260kg （60m3/min)"]
[null,null,null,null,null,"③自走 9,140kg （30m3/min)"]
[null,"バックホウ",2,null,"運搬　・　操作","①0.45m3級"]
[null,null,null,null,null,"②0.8m3級　遠隔操縦式"]
[null,"分解組立型バックホウ",1,null,"運搬　・　分解組立　・　操作","機械総質量　約 25,000kg\n１ﾌﾞﾛｯｸ 2,800kg以下"]
[]
[null,"簡易遠隔操縦装置",2,null,"運搬　・　設置撤去　・　操作","①ﾊﾞｯｸﾎｳ用　75kg"]
[null,null,null,null,null,"②ﾊﾞｯｸﾎｳ用　75kg"]
[null,"応急組立橋",2,null,"運搬　・　架設　・　撤収","①支間長 30m/架設質量53.8t"]
[null,null,null,null,null,"②支間長 40m/架設質量120.5t"]
[null,"不整地運搬車",1,null,"運搬　・　操作","3,110kg"]
[]
[null,"災害対策用照明装置",1,null,"運搬　・　設置撤去　・　操作","1,295kg"]
[]
[null,"橋梁点検車",1,null,"運搬　・　操作","自走 24,940ｋｇ"]
[]
[null,"作業車",1,"○","運搬　・　操作","自走 7,990kg"]
[]
[null,"散水車",1,"○","運搬　・　操作","自走 12,200kg"]
[]
[null,"資機材等","－","○","運搬　・　設置撤去　・　操作","①クレーン吊上 移動装置\n②フォークリフト移動装置\n③人力移動装置\n④大型土嚢、大型土嚢袋詰機\n⑤ジャッキ付コンテナ\n⑥可搬式遠隔操作室\n⑦つかみ装置\n⑧油圧ブレーカ等"]
[null,null,null,null,null,"自走車の質量：車両総質量"]
["※１","実際に行う作業内容については、要請事務所等との契約時に決定します。"]
[null,"※運搬とは、災対機械等の保管場所から出動場所までの間の出動又は返納に要する作業である。"]
[null,"※設置撤去、分解組立とは、機械が稼働（操作）できる状態又は撤収できる状態までに要する作業である。"]
[null,"※操作とは、機械の稼働・停止に係る作業である。"]
[null,"※架設・撤収とは、応急組立橋を架設する作業、応急組立橋を返納時に運搬できる状態までに要する作業である。"]

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[null,"（記入例）"]
[null,"〔様式－３〕",null,"会社名　：","○○○○株式会社"]
[]
[null,"９．（３）工事、業務、役務の提供等の施工実績　（１件記載）"]
[null,"施工実績","契約等件名"]
[null,null,"契約の相手方"]
[null,null,null,"担当部署　："]
[null,null,null,"機関の別　："]
[null,null,"契約期間"]
[null,null,"契約内容の概要"]
[]
[null,"９．（４）災害時における出動作業の実績　（１件記載）"]
[null,"出動作業実績","契約等件名","　排水ポンプ車運搬"]
[null,null,"協定の相手方","　九州地方整備局　九州技術事務所"]
[null,null,null,"担当部署　：","技術活用・人材育成課"]
[null,null,null,"機関の別　：","　国"]
[null,null,"作業日（期間）","　R３．○．○ ～ R３．○．○"]
[null,null,"出動した災対機械等","　排水ポンプ車　・　１台"]
[null,null,"出動した災対機械等保有機関名","  九州地方整備局  九州技術事務所"]
[]
[null,"９．（５）災害時における応急復旧工事、応急対策業務等の実績　（１件記載）"]
[null,"災害対応作業実績","契約等件名","　資機材等製造"]
[null,null,"協定の相手方","　九州地方整備局　○○河川国道事務所"]
[null,null,null,"担当部署　：","防災課"]
[null,null,null,"機関の別　：","　国"]
[null,null,"作業日（期間）","　Ｈ２４．○．○ ～ Ｈ２４．○．○"]
[null,null,"災害対応作業の内容","　覆鋼板　２０枚　（購入、運搬、敷設）"]
[]
[null,"９．（６）災害時における上記（４）又は（５）に関わる協定締結実績　（１件記載）"]
[null,"協定締結実績","協定等名","　災害時における応急対策業務に関する基本協定"]
[null,null,"協定の相手方","　九州地方整備局　九州技術事務所"]
[null,null,null,"機関の別　：","　国"]
[null,null,"協定期間","　Ｈ２４．４．１ ～ Ｈ２５．３．３１"]
[null,null,"協定の内容及び\n協定対象機械名等","　対策本部車、待機支援車、情報収集車、排水ポンプ車\n　照明車、作業車、土のう造成機、簡易遠隔操縦装置"]
[null,null,null,"　内容　：　災害時の災害対策用機械出動（８機種）"]
[]
[null,"９．（７）災対機械等の製造、保守点検又は修繕実績　（１件記載）"]
[null,"保守点検実績","契約等件名","　災害対策用機械等点検業務"]
[null,null,"契約の相手方","　九州地方整備局　九州技術事務所"]
[null,null,null,"担当部署　：","技術活用・人材育成課"]
[null,null,null,"機関の別　：","　国"]
[null,null,"契約期間","　R３．４．１ ～ R４．３．３１"]
[null,null,"対象となる災対機械名等","　排水ポンプ車外"]
[]
[null,"※","記載にあたっての留意点は、以下のとおりです。"]
[null,"１．","契約の実績がわかるものの写しを添付して下さい。（記入内容が判明するページのみで可）"]
[null,"２．","施工実績、出動作業、応急復旧工事等の実績が判断できる資料（契約書、災害時における出動等要請書、協議書等）の写し、協定書の写しおよび対象機械等が判る資料の写しを添付して下さい。（記入内容が判明するページのみで可）"]
[null,"３．","契約等件名や協定等件名は、正式な件名を記入して下さい。"]
[null,"４．","契約や協定の相手方は、正式名称を記入して下さい。"]
[null,"５．","出動作業、協定、保守点検の対象となる災対機械等が多数の場合は、代表的なものを「１～２機種」記入して下さい。"]

{"sheet":"様式４ (記入例)","index":7,"n_rows":33,"n_cols":10,"rows_kept":33,"cut":false,"hidden":false,"merged":[[10,8,10,9],[11,3,11,4],[11,8,11,9],[15,3,15,4],[15,8,15,9],[13,3,13,4],[0,1,0,9],[20,2,20,9],[1,1,1,2],[1,5,1,9],[3,1,3,9],[4,1,4,9],[8,1,9,2],[8,3,9,4],[8,5,8,9],[9,8,9,9],[9,6,9,7],[10,1,12,2],[10,3,10,4],[12,3,12,4],[12,8,12,9],[17,3,17,4],[32,2,33,9],[23,5,23,9],[24,5,24,9],[28,5,28,9],[29,5,29,9],[17,8,17,9],[19,2,19,9],[21,1,21,9],[22,1,22,5],[13,1,17,2],[13,8,13,9],[14,3,14,4],[14,8,14,9],[16,3,16,4],[16,8,16,9]]}
[null,"（記入例）"]
[null,"〔様式－４〕　　　　　　　　（記載例）",null,null,"会社名　：","○○○○株式会社"]
[]
[null,"９．（８）派遣作業員数及び資格保有者状況"]
[null,"　　①本協定に従事する作業員数"]
[null,null,null,null,"従事する作業員数",null,"○○",null,"人"]
[]
[null,null,"②本協定に従事する作業員の保有資格者状況"]
[null,"区分",null,"免許・資格等名",null,"資格保有者状況"]
[null,null,null,null,null,"いる","人数",null,"いない"]
[null,"免許・資格",null,"一級・二級\n土木施工管理技士",null,null,null,"人","○"]
[null,null,null,"大型自動車運転",null,"○","○○","人"]
[null,null,null,"移動式クレーン運転",null,null,null,"人","○"]
[null,"技能講習",null,"玉掛け",null,"○","○","人"]
[null,null,null,"小型移動式クレーン運転",null,"○","○","人"]
[null,null,null,"高所作業車運転・10ｍ以上",null,"○","○","人"]
[null,null,null,"車両系建設機械運転（整地等）",null,"○","○","人"]
[null,null,null,"不整地運搬車運転",null,null,null,"人","○"]
[]
[null,"※","各種免許・資格等の保有者で、当該協定に従事可能な資格保有者状況を「いる」「いない」欄のいずれかに丸印及び人数を記入して下さい。"]
[]
[null,"９．（９）派遣作業員の所属する部署の所在地"]
[null,"　　①派遣作業員の所属する部署の所在地"]
[null,null,"営業所等－１",null,"名称　：","○○営業所"]
[null,null,null,null,"住所　：","福岡県久留米市○○町○○１丁目１２３４番地"]
[null,null,null,null,"九州技術事務所までの距離：",null,null,null,13,"㎞"]
[null,null,null,null,"　　　　　　〃　　　　　　時間：",null,0,"時間",25,"分"]
[]
[null,null,"営業所等－２　　",null,"名称　："]
[null,null,null,null,"住所　："]
[null,null,null,null,"九州技術事務所までの距離：",null,null,null,null,"㎞"]
[null,null,null,null,"　　　　　　〃　　　　　　時間：",null,null,"時間",null,"分"]
[null,null,"※ ・所属する部署が複数箇所存在する場合、九州技術事務所に近い順から２カ所を記載してください。\n　　・九州技術事務所までの距離は、一般道での距離を記載して下さい。\n　　・営業所から九州技術事務所までの距離が確認できる資料（地図等）を添付して下さい。\n　　"]