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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all i <br />amendments (if any) are no longer in effect. 2020 FEB _6 PM Li: 23 <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 SAWA ANA <br />Is the agreement(s)apermanent record? Yes _ No CLERK OF COUNCIL <br />I <br />Return form to the Clerk of the Council Office (M-30). I <br />Call 647-1520 if you have any questions. <br />The agreement with <br />No. N-2019-072 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />Only <br />,30/1 and final payment has been made. <br />Department: PRC5111 <br />Phone/Ext.: y►� <br />Signature: <br />Date: Io10 <br />