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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amendments (if any) are no longer in effect.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 KAryy) FOyytb`r <br />COTC Office Use Onlv <br />No. N-2021-113 was completed on 14t3o [U21 and final payment has been made. <br />(Lis f all amendments. Use space below if needed.) <br />Department: CpA lkfb 3 (AAAlVt. -C, <br />Phone/Ext.: Cjj�5 (rt9 C 5 35S <br />Signature: 4Nabix4 LS16.- CMAZ�. <br />Date: (a-13DI ZMA <br />dagreementsWormsVorm- agreement termination form_goldenrod.doc <br />