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City of Santa Ana <br />°y Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement aro1�l <br />amendments (if any) are no longer in effect. <br />Nate: If your agreement is grant related, please ensure that all grant retention requirements CITY <br />have been satisfied prior to signing the termination form. CLEF <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 />19 PM 3- R 7 <br />SANTA ANA <br />OF COUNCIL <br />No. fl 0\-'— Ooi,4 was completed on 9, & - /8 <br />and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: <br />/y mm /n� <br />l./�VJ/"1 <br />Phone/Ext.: <br />(p/� <br />Signature: <br />�%j <br />X� <br />Date: <br />`/� & l� <br />Revised: 10-18-16 <br />