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City of Santa Ana <br />Clerk of the Council COTC Office Use Only <br />AGREEMENT TERMINATION FORM —� <br />Please complete this form in its entirety when the attached agreement and991 SEP 77 _ pM 3� 11 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements C� T OF SANTA A NA <br />have been satisfied prior to signing the termination form. Cj- RK OF COU!j'Cjj, <br />I <br />i <br />Is the agreement(s) a permanent record? Yes _ No <br />I <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 01 chae"l pyWA - W 4Lak:c. <br />No. N-2018-085 was completed one woe-- i i and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: C'Djq <br />Phone/Ext.: 53 1-5 y� <br />Signature: [9 r dY�A ` l rw��d .n <br />Date: <br />Revised 1478-16 <br />