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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 and aly .1 l <br />amendments (if any) are no longer in effect. ` 4 Au <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY Q, S ANTA AN1� <br />have been satisfied prior to signing the termination form. CI_F \ OF COUNCIL <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. The agreement with pn46x/ <br />No. N-2017-151 was completed on <br />(List all amendments. Use space below if needed.) <br />Oi and final payment has been made. <br />Department: <br />PRCLA <br />Phone/Ext.: <br />y a l q <br />Signature: <br />Date: <br />7y I Iq <br />holq <br />Revised: 10-1 a-16 <br />