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City of Santa P-+a <br />t Clerk of the Cou!.._il coTc Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. Ct=y of manta Ana <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form•-1J o 2 Ems' <br />Is the agreement(s) a permanent record? Yes No Cierk of the Council <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 />A-2017-217-02 <br />No. _ was completed on L and final payment has been made. <br />(List afi amendments. use space below if needed.) 1 <br />Pr_,—I_�� Department: �•05W (t`y�YYytV� <br />(�--(3r)11--:;)-`-1-0 i Phone/Ext.: 5DS� <br />14—aoll` l)SS— Signature: ��izliA,�C1/�il� <br />Date: 7 !oZ% I---,,\-1 <br />Revised: 10-18-16 <br />