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City of Santos Ana <br />Clerk of fhe Council cote afFice use only <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. -;--3 _- <br />Nate: If your agreement is grant related, please ensure that all grant retenton 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 A White and Yellow Cob Company <br />c 2otsf <br />No. A- 2008 -335 (IB) was completed on <br />12118109 <br />and final payment has been made. <br />�Z (Ust all amendments. Use space below if needed.} <br />PC-MK -260 (1) core <br />Department: <br />PWA <br />1H R•2.00I-252 (I p) *A-411-013 (lb) <br />Phone /Ext.: <br />261,2 — <br />�4 A -�-6 q -V6 rrIC' <br />0 @ � <br />Signature: <br />S <br />����, �(' , <br />A 200q-2A6'01 (ID) <br />Date: <br />11201b <br />Reuised:01-07-16 <br />