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City of Santa Ana C20ib <br /> 1141 Clerk of the Council s <br /> S -- COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form when the attached agreement and all r <br /> amendments (if any) are no longer in effect. � �f erg j <br /> 1 <br /> Note: If your agreement is grant related, please ensure that all grant retention requirementsCIT , 1^ <br /> have been satisfied prior to signing the termination form. CIRVek OF } <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 21fa,a/L - . <br /> No. N-2016-135 was completed on 61 11 1 1.Le and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: ?PeS <br /> Phone/Ext.: S a-S-L-{' <br /> Signature: � ��LC QQ A,'CR.-Q <br /> Date: <br /> Revised:01-07-16 <br />