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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amendments (if any) are no longer in effect.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 f t dJ'T\'Gb (ViULVkA <br />COTC Office Use Only <br />No. N-2021-124 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />iiagreementMformslform-agreement term ination form _goldenrod.doc <br />Department: OVA It Mi—> 3 CAk`' o'er <br />Phone/Ext.: 53�T5 er 5395 <br />Signature: I fti2AAlD &OWILi , <br />Date: 7AI <br />