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City of Santa Ana <br />*." Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />C-2Oil <br />Use Only <br />?t7 OCT <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect.I CTY r, n <br />SA °, 'Hi x. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements un! -c R f f= r <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 <br />No. N-2017-006 was completed onand final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: � Pv <br />Phone/Ext.: <br />Signature: I V C'. l -t P )Ci'D <br />Date: <br />Revised: 10-18-16 <br />