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City of Santa Ana <br />-w Clerk of the Council <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amendments (if any) are no longer in effect. C,EE <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 />OF THE CGUN-1�011- <br />5'21 PM3:i.5 <br />A-2019-077 t7 (5 Zr�2� <br />No. was completed on and final payment has been made. <br />(List uu amendments. Use space below if needed.) (� n /�/ <br />Department: !i/ ,O N — /'c �il i n <br />Phone/Ext.: 7. YJ`/ 2� <br />Signature: <br />Date: 20 <br />Revised: 10-18-16 <br />