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City of Santa / j <br />Clerk of the Council corc orfice Use Only <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amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements City of Santa Ana <br />have been satisfied prior to signing the termination form. FF [ M <br />Is the agreement(s) a permanent record? Yes No <br />Clerk of the Council <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-2018-106 was completed on i )) 1 2� and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department:�i� <br />Phone/Ext.: J� <br />Signature: QAkv C" <br />Date: =71,27 <br />Revised: 10-18-16 <br />