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City of Santa A %i <br />Clerk of the Cour,.,,f <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety 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amendments (if any) are no longer in effect.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 />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office Use Only <br />City of Santa Ana <br />A(j 02 2621 <br />Clerk of the Council <br />The agreement with (� � �(� V l(� 1�E Y\sQV 1 Yt�k- Lf`)As lky,6 l:!, <br />No. 0 aU 11-099c 2 was completed on 1 l and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />(2V-3C,\1—Cs�-0\ Department:-Q1x—�6\al <br />P\- 0V-7-.isa <br />Phone/Ext.: <br />n� <br />�ate � � Signature: `l�'`�-1 C�r�Ctl/� <br />Revised: 10-18-I6 <br />