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City of Santa Ana <br />i Clerk of the Cou1- d <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amendments (if any) are no longer in effect.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 />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 agreements) 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 h ojk` <br />City of Santa Ana <br />A a 02 2021 <br />Clerk of the Council <br />N-2019-089 <br />No. was completed on \0 1 and final payment has been made. <br />(List all amendments. Use space below if needed.) , <br />Department: ?a r.Si�-/ �vn,A <br />Phone/Ext.: <br />Signature: U/ a� <br />Date: <br />Revised: 10-18-16 <br />