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City of Santa Ana <br />Clerk of the Council COTC Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all7" AUr 22 P, It: (;u <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF c: ;"N H TA A N A <br />have been satisfied prior to signing the termination form. CLERK O ~ COUNCIL <br />Is the agreement(s) a permanent record? Yes _ No <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with \ YY*eX0,, <br />N-2017-118-01 <br />No. was completed on (Z)3olaot—t and final payment has been made. <br />(List all amendments. Use space below if needed.) Department: P R C S A <br />Phone/Ext.: 143A <br />Signature: 'l1oiNa/ — <br />Date: R l a0 1a0 M <br />Revised: 10-18-16 <br />