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City of Santa Ana CUTC 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amendments (if any) are no longer in effect.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 />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 />s 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 Flo (� am <br />No. N-2022-175 was completed on 7111'�7 <br />(List all amendments. <br />Use space below if needed) <br />Department: <br />Phone/Ext.: <br />Signature: <br />©ate: <br />i:lagreemenlstformsVorm - agreement termination form_goldenrod.doc <br />City of Santa Ans. <br />City ClerWs Office <br />and final payment has been made. <br />