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City of Santa Ana <br />rat 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amendments (if any) are no longer in effect. Q: <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. CITY OF SA Ed TA A N A <br />Is the agreement(s)apermanent record? Yes _ No GL_ERiK OF COUNCIL <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-2019-039 was completed on <br />(List all amendments. Use space below N needed.) <br />Revised: 10-18-16 <br />Use Only <br />1 1716 and final payment has been made. <br />Department: PzcSA <br />Phone/Ext.: 14'R1q <br />Signature: ALI <br />Date: <br />0 <br />