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City of Santa Ana <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amendments (if any) are no longer in effect.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 Cu rW [.-[.ty <br />N-2021-017 <br />No. <br />(List all amendments. <br />was completed on % INLULA <br />Use space below if needed.I <br />Department: CVA t Mb 3 QiAbA , <br />r,agreemenls`forms`fonn-agreement tenninafon form —goldenrod doc <br />COTC Office Use OnW <br />and final payment has been made. <br />Phone/Ext.: 53 O56-,, <br />Signature: xA'cAbIIIV(r _SA."Yrl�.�� <br />Date: �J <br />