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City of Santa Ana COM Office Use Onty ✓ <br />-.. 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amendments (if any) are no longer in effect.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 />No. <br />QN&�W\ Y-0 car i C' <br />N-2020-173 was completed on ►0109 tWjj and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: QQC$(� <br />Phone/Ext.: F:1 q <br />Signature: <br />p <br />Date: \\11420 <br />i9agreementslformsUorm-agreement termination form_goldenroi <br />