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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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />Fi C: `21 P6v=, 06 <br />The agreement with PAV*e - it D S tt't-r-e-g . <br />No. N-2021-112 was completed on j �o��oZl and final payment has been made. <br />(List all amendments. Use space below N needed) <br />Department: CZA�._A 5 3 CaAALVEL, <br />Phone/Ext.: E-5 Q( Cj j`J <br />Signature: Sj^l,C �.� <br />Date: (a 0Z1 <br />