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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 -11, SET I3 <br />amendments (if any) are no longer in effect. <br />r <br />Note: If your agreement is grant related, please ensure that all grant retention requiremeQT � <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 />The agreement with <br />No. t4 -2016-11L was completed on ��) Lp and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: S-4 <br />Signature: �ylG �3fA11Ci0�a� <br />Date: <br />Revised: 01-07-16 <br />