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City of Santa Ana <br />.� J1 coTc Olfice Use Only <br />�,r t Clerk of the Cot ' <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amendments (if any) are no longer in effect.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 City of Santa Ana <br />have been satisfied prior to signing the termination form. <br />Is the agreements) a permanent record? Yes No �'' Q 2M, <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. 1 , / <br />The agreement with placed Wf�`C Y lc 1 \nr <br />No. A-w!2g— o:o was completed on 1�` I and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: T Y -VA <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 1 Q 18-16 <br />