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City of Santa Ana <br />-r Clerk of the Council <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amendments (if any) are no longer in effect..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 <br />No. N-2019-107 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-I6 <br />COTC Office Use <br />FE® -6 PH 4: 23 <br />C1T� OF SANTA ANA <br />CLERK OF COUNCrL <br />/j'3jg0j9 and final payment has been made. <br />Department: PRcspt <br />Phone/Ext.: u2 161 <br />Signature: <br />Date: vi�f'aG'1�1 <br />yb�O Ws <br />