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City of Santa Ana Clerk of the Council ... .. ..... <br />COTC Office Use Only <br />.. ..... . .... <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amendments (if any) are no longer in effect.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 <br />No. N-2019-008 was completed on I -Al j7()t!i and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: MOM <br />Phone/Ext.: <br />Signature: <br />Date: X% 10 a 110) <br />Revised: I G-18-16 <br />