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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amendments (if any) are no longer in effect. <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. <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 peulla C G&PAI <br />No. N-2019-004 was completed on 12 j3112OXot and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: MCEIN <br />Phone/Ext.: 5211-1 <br />Signature: &nh <br />YI-1 <br />Date: 1202A <br />0 Revised: 10-18-16 <br />