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City of Santa Ana COTC office Use Only <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amendments (if any) are no longer in effect.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 />` i_ <br />Note: If your agreement is grant related, please ensure that all grant retention requirements y <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 YIihe.{ Vjv./.(e 5 Qy f sbft- ' PCmu-< , Lj�P <br />No. A-2019-038-01 was completed on � "2 and final payment has been made. <br />(List all amendments. Use space below if needed.) (��,11ee 22 <br />Department: F6°r"r S /� � C�T'2fiL SvrS` <br />Phone/Ext.: )( 5-y 0 'L <br />Signature: <br />Date: <br />i lagreemenlsVormslfarm- agreement termination form_goldenrod.doc <br />