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�> tort onl�e Use oow <br />City of Santa Ana <br />Clerk of the Council i <br />AGREEMENT TERMINATION FORM <br />CLERk OF THE COUNCIL <br />AIN 31'23 PM3:50 <br />Please complete this form in its entirety when the attached agreement and a I <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all rant 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 I l c 5 �V, e <br />A-2020-043-11 <br />No. _ was completed on 0"I —C;)��nd final payment has been made. <br />(List all amendments. Use space below ff needed.) <br />Department: <br />Phone/Ext.: �� 1 <br />Signature: �---� <br />Date: <br />ilagreements4ormslform - agreement termination form_goldenrod.doe <br />