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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amendments (if any) are no longer in effect.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 agreements} a permanent record? Yes No <br />COTC Office Use Only <br />(:�,21( <br />Return form to the Clerk of the Council Office (M-30). gi p <br />Cali 647-1520 if you have any questions. <br />yg <br />a i3 .- _y. o S 22 m5 a 12 <br />The agreement with utti6 pr c�td -G , Inc <br />No. N-2021-190 was completed on <br />(List all amendments. Use space below if needed <br />6agreementsVorrmform - agreement termination form—goldenrod.doc <br />Department <br />and final payment has been made. <br />Phone/Ext.: <br />Signature: <br />Date: -7 �f <br />