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City of Santa Ana ...... <br />Clerk of the Council COTC Office Use Only <br />.. .. ..... <br />.. .... - <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amendments (if any) are no longer in effect.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 />C;'Ly of Santa Ana <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 />0 42 2021 <br />Is the agreement(s) a permanent record? Yes No)L <br />Clerk of the C'ouncii <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 —'NQ Wj'� I,- d a=3AQ <br />No. N-2019423 was completed on 71 JS LobIIC and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PF65A <br />Phone/Ext.: <br />Signature: <br />Date: 116 lain KI <br />Revised: 10-18-16 <br />