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City of Santa Ana <br />""'�•'� Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all 71,19 AUG <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amendments (if any) are no longer in effect.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 <br />have been satisfied prior to signing the termination form. CLERK <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 />No. N-2016-025 was completed on I 7 <br />(List all amendments. Use space below if needed.) f C /� <br />Department: 1� c, F- j� <br />COTC Office Use Only <br />I pt4 LE: 59 <br />NTA AA <br />COUNCIL <br />and final payment has been made. <br />Phone/Ext.: <br />Signature: <br />Date: SI Iq 1 `Ron <br />Revised: 01-07-16 <br />