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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amendments (if any) are no longer in effect.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 PtvtU7 L."eT <br />No. N-2021-118 was completed on <br />(List all amendments. Use space below if needed.) <br />i:\agreements\forms\forrn - agreement termination form_goldenrod.dx <br />COTC Office Use Only <br />FWTH <br />r!. 0_ <br />Loa I SOT and final payment has been made. <br />Department: Calk `fk(b <br />Phone/Ext.: p5 3RCi�C 5 �� <br />Signature: t rk7,3p., M MU 34a la[aimAQA <br />Date: u,13 <br />