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City of Santa Ana <br />Clerk of the Council corcoxloeuseomy <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all F <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amendments (if any) are no longer in effect.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. p <br />The agreement with <br />A-2019-038 was completed on and final payment has been made. <br />(, 3 2 Z <br />No. _ <br />(List all amendments. Use space below if needed.) <br />Department: f01 S k ' C¢^7' ego' SrJCs <br />Phone/Ext.: X,. -qO 2� / <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />