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City of Santa Ana G20l.IP <br />Clerk of the Council COTC Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. ( OCT 31 AM H- 33 <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. C TY OF SANTA ANA <br />CLERK OF COUNCIL <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement withQ,�r Jl <br />No. I ®� was completed on (OR/IV V and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />{ <br />Department: Wow <br />7Y+ IS � <br />Phone/Ext.: �J�✓! <br />Signature: 1 WWT <br />Date:1 W <br />Revised: 01-07-16 <br />