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City of Santa ,Ana <br />l 1� Clerk of the Council cozc aff��� use only <br />AGREEMENT TERMINATION FORM C0 <br />Please complete this form in its entirety when the attached agreement -and all. - ;I <br />amendments (if any) are no longer in effect. <br />Mote: 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). i <br />Call 647-1520 if you have any questions. <br />The agreement with VM"Aflq MCI UX1Q11U C-Oclf, P-V)MCef1"'r 1 I <br />A-2019-094-03 <br />No. was completed on � and final payment has been made. <br />(List all amendments. Use space below if needed <br />Department: <br />Phone/Ext.: c <br />Signature:. <br />Date - <br />Revised: 10-18-75 ( LS) <br />