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City of Santa Ana <br /> �f.:4, .;' Clerk of the Council COTO Office Use Only <br /> • <br /> AGREEMENT TERMINATION FORM <br /> • <br /> Please complete this form in its entirety when the attached agreement and all <br /> amendments (if any) are no longer in effect. <br /> • <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 /> • <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. j <br /> The agreement withO YYtmul/1 l 'id Y\ -i`- vu2 A l/�I. oc, <br /> p - n C <br /> A-2019-094-12B <br /> No. was completed on g — 1 _7& and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: .. l .1) A <br /> Phone/Ext.: (.0 5 ' <br /> Signature: '���� <br /> Date: 9 i --z(J <br /> Revised: 10-18-16 <br />