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City of Santa Ana <br />Clerk of the Co Al 1 COTC Office Use Only <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amendments (if any) are no longer in effect. SANTA ANA CITY CLERK <br />Note: If your agreement is grant related, please ensure that all grant retention requirements MAO 13123 PM3:411 <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 aareement with Jw vu (kr W ' (/►CM L(:lT" <br />A-2019-097 r (� <br />No. was completed o4-1-xx20nd final payment has bee ade. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />t� <br />Date: f az <br />Revised: 10-18-16 <br />