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City of Santa Ana <br />Clerk of the Council <br />COTC Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement <br />and all <br />amendments (if any) are no longer in effect. <br />LSu?+K a i THE MILINCIL <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />,r; V4 <br />V- # 9•ry7 j <br />have been satisfied prior to signing the termination form.¢ <br />I <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 />The agreement with <br />The \ <br />N-2018-013'' C � <br />No. was completed on <br />and final payment has been made. <br />(List all amendments. Use space below if needed) <br />Department: <br />PRCM <br />Phone/Ext.: <br />l� <br />521 Q <br />Signature: <br />Date: <br />111 % 11202 <br />Revised: 10-18-16 <br />