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City of Santa AnaCOTC Off <br />Clerk of the Council ------ ---- ....... ............... .. - <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemeaRGI-Wall <br />amendments (if any) are no longer in effect. <br />(-ITY M T11% I IN A <br />Note: if your agreement is grant related, please ensure that all grant retention requirement s�% i I <br />Ak nF, <br />have been satisfied prior to signing the termination form. <br />Is the agreement(s) a permanent record? Yes — No <br />Return form to the Clerk of the Council office (M-30). <br />Call647-1520 if you have any questions. <br />The agreement with <br />Use Only <br />was completed on g1j, <br />No. N-2017-162 �2] 1:1 and final payment has been made. <br />(List all amendments. Use space below if needed.) Department: -PRC5—+4 <br />Phone/Ext.: <br />Signature: A! &0 <br />Date: I C) 'ivO <br />Revised: 10-18-16 <br />