Contract Termination Request

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Date: To: Indiana Department of Administration IDOA Contract Termination Request, contracttermination From: Contract Number: Contractor Name: Contact Name: Email Address: Description of Services: Specify Termination for Default or Convenience: Describe the Reason for Contract Termination: Page 1 of 2 Contract Termination Letter Request Effective Date of Termination (must meet contractual notice requirements): Agency/Division Names and e-mails to be CC’d on Termination Notice: Name E-mail NOTE: If equipment shall be returned to the State by the Contractor, provide a detailed list to include in the letter..

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