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_ City of Santa A 7 <br />Clerk of the Counc l <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement arr, II L 19 PI 3: 06 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF SANTA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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. 14 —L:3,0 I— b � was completed on 361 C1 and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: Q )2 SA <br />Phone/Ext.: ��- <br />Signature: 'sli Of)\ CA QA)WfA/-) <br />Date: -7) [9f W <br />Revised: 10-18-16 <br />