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City of Santa Ana <br />®w Clerk of the Council <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amendments (if any) are no longer in effect.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 <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 />COTC Office Use Only <br />1}#+F 7 f-"ate c ouy. �-M <br />_=v.,_ <br />IP$0,21 r <br />No. N-2019-254-01 was completed on (,a3y 1 -lam <br />and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />iiagreementstfonns,form- agreement termination form galdenroti <br />Department: CO Q <br />Phone/Ext.: oc 5Q >115-5 <br />Signature: <br />Date: (� <br />