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City of Santa Ana <br />. r ��. Clerk of the Cou II COTC Office Use Only <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amendments (if any) are no longer in effect.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 />City of Santa Ana <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. 1E21 <br />!aan <br />Is the agreement(s) a permanent record? Yes No <br />Clerk of the 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 DI S C-CVe-r\4 _ t P 0 <br />N-2019-067 <br />No. was completed on���J�_ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: P Mk t� <br />Phone/Ext.: <br />Signature: UkA/ <br />Date: _70-7 ; d <br />Revised: 10-18-16 <br />t.� <br />