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City of Santa Ana <br />Clerk of the Council <br />' - k <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />13 r% ' n 4 <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amendments (if any) are no longer in effect.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 G 2 G! <br />No.�y�as completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) r <br />10 Of) cn►p, Department: Z7/ /��il�✓� ,dl1C�'%/il <br />T-' <br />- 1601 —Iql Phone/Ext.: �5-_G Z i <br />Signature: <br />Date:�� <br />Revised 08-23-10 <br />