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City of Santa Ana <br />t Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. <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 />- coJ <br />COTC Office Use Only <br />OF TH_= COistsCEL <br />13'2-1 P143:07 <br />Occn5e t�i2�oCo�� <br />t>S��JIo3l 0 <br />No. 20L0— 01.01 was completed on V900"It and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />V en 0 Y 6� �00rj <br />Revised: 10.18-16 <br />Department: D A 1) L Lk CC'� el <br />Phone/Ext.: <br />Signature: <br />t <br />Date: Q%'t - 0 9 - <br />