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City of Santa Ana <br />Clerk of the Council I <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amendments (if any) are no longer in effect.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 ; E <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 <br />Sv LS <br />No. A-2020-043-01 was completed on <br />(List all amendments. Use space below if needed.) <br />i7agreementsWormslform- agreement termination form_goldenrod.doc <br />COTC Office Use On <br />OF <br />1-7 ;=v <br />e� ' 30 '-71�and final payment has been made. <br />Department: <br />,�5,—PA <br />Phone/Ext.: �6 <br />Signature: <br />_r <br />Date: <br />