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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM 1 <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. (-- LEl <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 v <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 5 <br />N-2019-009 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />OF THE COUNCiL <br />I Q-'22 Am,11:10 <br />and final payment has been made. <br />Department:�CS� <br />Phone/Ext.: <br />Signature: <br />Date: <br />