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City of Santa A -a <br />- - <br />Clerk of the Cours, rl COTC Office <br />~ AGREEMENT TERMINATION FORM C <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. City of Santa 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. i Ali j 0 2 2021 <br />Is the agreement(s) a permanent record? Yes No Clerk of the Council <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. 66'� n-^ <br />The agreement with f YwiG r% . <br />No. )Pr-'Ro �-j -P� was completed on 1,3j 311 VC and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />,PC—ac \`1- [ r�Y -(} Department: �� Si J i�iti Y�CVL. <br />p'--aof-1- Phone/Ext.:" <br />Revised: 10-19-16 <br />Signature: S A) LL , Cj-k /(�10 <br />Date: ��� IQ \ <br />