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0City of Santa Ana COTC Office Use Only <br />'� t 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amendments (if any) are no longer in effect.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 Mm fh rga j 1 kl no, - <br />No. N-2019-214-02 was completed on U and final payment has been made. <br />(List all amendments. Use space below if needed.) _ I <br />Department: �� IThis 3oil L�� <br />Phone/Ext.: ' %5 p{ 5355 <br />Signature: T�+A QU nUk—) <br />Date: Q Z1 <br />itagreementsfermsform- agreement termination form goldenrod. doe <br />