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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 <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amendments (if any) are no longer in effect.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 />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office <br />w 31 Mil 11134 <br />SANTA ANA <br />OF COUNC11 <br />c 201 <br />The agreement with tj Akhj LQ �(, f ()'Vy},dOL-- 6 y; <br />11 A <br />No. jk® I(. a , i L b was completed on lie and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: C i4qMomcjG y- s ( [ <br />V <br />Phone/Ext.: <br />Signature: <br />u <br />Date: ��✓I Ila <br />Revised: 01-07-16 <br />