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City of Santa Ana <br />Clerk of the Council cor Otrice use <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amendments (if any) are no longer in effect.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 />Note: If your agreement is grant related, please ensure that all grant retention requirements CLER �� �� QllfiCYL <br />have been satisfied prior to signing the termination form. <br />n I R 20'22 art9:16 <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 TA /Qdlevt <br />zt <br />No. -y r ) � 191 • 22`i was completed on t 2-f 3 r MoL and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 'PWA <br />Phone/Ext.: 33 1,Ci <br />Signature: <br />Revised: 10-18-16 Date: <br />