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City of Santa Ana <br />Clerk of the Council I �� <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and <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amendments (if any) are no longer in effect.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. <br />The agreement with C1 �TA 1 «P' <br />No. N-2019-083 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 1 Q 18-16 <br />U CA- <br />COTC Office Use Only <br />1H COUNCIL <br />`,'22 mll: T9 <br />and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: C <br />Date: <br />