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City of Santa Ana <br />Clerk of the Council ^1 l COTc orrice Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and ails <br />amendments (if any) are no longer in effect. THE C01jmCIL <br />Note: If your agreement is grant related, please ensure that all grant retention requirements `TAN 31 '23 PM3:5$ <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 t " ` / 6 / 1 5io6 caie-9j <br />A-2018-091-01 it 'L(� ZZ <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) rr�/n <br />Department: W1+ <br />Phone/Ext.: &S (c <br />Signature: � ) - <br />Date: <br />Revised: 10-18-16 <br />