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��- City of Santa Ana <br /> #4 y. Clerk of the Council COiC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete <br /> his arein tsentiretyn when <br /> the attached agreement and arylf ff; 2L f,i <br /> (ifany) nolonger <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements (( l <br /> have been satisfied prior to signing the termination form. Cf V pK 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. <br /> The agreement with <br /> No. A-2018-135-17A �t .� u'� C1 <br /> was completed on . , and final payment has been made. <br /> (List an amendments. Use space below if needed.) <br /> Department: . , A <br /> N"vv\'41' ,kt cek,471,A. \V\ <br /> Phone/Ext.: (0 S (e <br /> Signature: <br /> Date: (n - 3 —'( <br /> Revised: 10-18-16 <br />