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City of Santa Ana <br /> - , ii Clerk of the Council COTC Office Use Only <br /> ""'"`T AGREEMENT TERMINATION FORM <br /> Please complete this form when the attached agreement and all <br /> amendments (if any) are no longer in effect. j I <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements <br /> • <br /> have been satisfied prior to signing the termination form. <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. <br /> /, ms <br /> The agreement with /k ' (/��/f/i-d Se/t c .. —7.7' <br /> .®e <br /> No. 4-420/ Z -/2as completed on 63l1 /.3 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: nofr- <br /> Phone/Ext.: � 0/ <br /> Signature: ,p�a€JAI' 5:4,30)-)i <br /> Date: /2... '// Y <br /> Revised:01-07-16 <br />