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City of Santa Ana <br />1 Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and�-u Al 4hy n n+, �• j <br />amendments (if any) are no longer in effect. <br />' <br />Note: If your agreement is grant related, please ensure that all grant retention requirements r,� , <br />l <br />have been satisfied prior to signing the termination form. n ,-., T „ r�. �. r ._ ,- n <br />Is the agreement(s) a permanent record? Yes No X <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 HAa2 y, I rJ <. <br />No. A • 2-0 1-1 . 2L1 a. was completed on l 2--2,1 (c, and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />� 50,p . ® 2-q Department: PU6L-t� tN Pt vwv <br />Phone/Ext.: S�Iq <br />Signature: <br />Date: L¢�ty�,`! <br />Revised: l e-18-16 <br />