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City of Santa Ana <br />�•., Clerk of the Council <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amendments (if any) are no longer in effect. ?(tlo <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. CIT <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 />No. N-2017-089 was completed on <br />(List all amendments. Use space below if needed.) <br />COTC Office Use Only <br />22 PM 4: r•7 <br />SANTA ANA <br />OF COUNCIL <br />cn/—?-�� and final payment has been made. <br />Department: PRG%A <br />Phone/Ext.: �pZfan <br />Signature: (YAAhJ 4::! <br />Date: Q��OLao k0, <br />Revised: 10-18-16 <br />