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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amendments (if any) are no longer in effect.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 />Nate: 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 />No 11 02W�9-~ 2�116 was completed on <br />(List all amendments. Use space below if needed.) <br />i <br />_o Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 01-07-16 <br />Gr�o(1 <br />Office Use <br />Kc 20 FM 1: ""E€ . <br />and final <br />payment has been made. <br />YSD /3 <br />