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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 01 Y,y -0, n!' <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements p) T ^ E <br />have been satisfied prior to signing the termination form. „ - <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 ( r'j c_, <br />No. A • 2-0 1-1 - 7 1 a- was completed on 2- 2-1 tG and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />A , s-Q I �'Q . ®Zq Department: PU 061� Wks P 6�f <br />Phone/Ext.: 33l`j <br />Signature: <br />Date: M/1�(,®t <br />Revised: 10-18-16 <br />