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City of Santa 1, to Clerk of the Cow icil ........................................ ...... ..... ................... . ...... <br />COTC Off ice Use Only <br />.......... ............ ................................. ..................... <br />AGREEMENT TERMINATION FORM ff <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />City of Santa Ana <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 />C) 2 <br />Is the agreement(s) a permanent record? Yes No <br />Ci'erk of ihe Cowincil <br />Return form to the Clerk of the Council Office (M-30). <br />Cail 647-1520 if you have any questions. <br />The agreement with <br />No. A —2—c) was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10- 18-16 <br />i /� I Lac .1 S and final payment has been made. <br />Department: vk I <br />Phone/Ext.: qajc <br />Signature: <br />Date: <br />T-S-�- <br />