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City of Santa Ana c�oiy <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M -30). <br />Call 647 -6520 if you have any questions. <br />The agreement with <br />N- 2012 -010 (I) <br />No. was completed on (d je ) f3 and final payment has been made. <br />�Z (List all amendments: Use space below if needed.) <br />74 t3- 2011-010-001 (IA) Department: Pic C —�-A <br />Phone /Ext.: <br />Signature: <br />Date: <br />7 <br />Revised 0 8-23 -10 <br />