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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amendments (if any) are no longer in effect.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 />The agreement with <br />C 'Ml <br />COTC Office Use Only <br />u10' P r. - <br />u `} 17 <br />OF - <br />I <br />3u i-A�♦_-� <br />No. N-2016-116 was completed on n and final payment has been made. <br />(List all amendments. Use space below ff needed.) <br />Department: <br />Phone/Ext.: <br />Signature: �j, (j n -1i CAI A)QA(0�0 <br />Date: k--)�oL L ( 0 <br />Revised: 01-07-16 <br />