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City of Santa Ana <br />t Clerk of the Council rTHE <br />AGREEMENT TERMINATION FORM <br />CL <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Nate: 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 µUtJIGIpAv W(k[ep_ 0kS4-tvT aTr— pPL^.oj� [pV�Vz+ <br />No. Q' 10k ol k ok1 was completed on I 1 yl 21 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: P 1nJg- <br />Phone/Ext.: 3 <br />Signature: �—' -- <br />Date: + ( I ' 11 <br />Revised: 10-7&16 at <br />