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City of Santa Ana <br />Clerk of the Council <br />COTC Office Use Only <br />--------------------------------------------------------------- <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and ali611 SEP 27 PH 3" 11 <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amendments (if any) are no longer in effect.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 S ANTA AM k <br />have been satisfied prior to signing the termination form. CLERK OF r(?h'"'( <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 <br />N-2018-086 <br />No. was completed on qi�'`J t 13 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: CDA' <br />Phone/Ext.: m5i <br />Signature: XA5'XA , o,, _o� mow) <br />Date: g12:911,a <br />Revised. 10-I & 16 <br />