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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amendments (if any) are no longer in effect.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 terminat[on farm. <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). <br />Call 547-1520 if you have any questions. <br />The agreement with Cqlb(r1 �COerionv��k d►C.rct �l <br />core office use only <br />CZ.02 <br />City of Same Ana <br />JAM 11 7024 <br />C"ity Clerk's Office <br />N-2022-250 � <br />No. - was completed on I! 7/1, and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 1 <br />Phone/Ext.:. <br />Signature: <br />Date: �—? /-,� I <br />�3- <br />1: lagreementsdorms\f- agreement termination form_goldenrod.doc <br />Ede <br />