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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement <br />amendments (if any) are no longer in effect. <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. <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-2018-022 was completed on 1 I <br />(List all amendments. Use space below if needed.) � �qQ <br />Department: P Y—�lpr <br />19 PH308 <br />SANTA ANA <br />OF COUNCIL <br />and final payment has been made. <br />Phone/Ext.: -7C.x=-� 4 <br />Signature: � c),oL�C/LJ� ��/�i�) <br />Date: 251 1+11 <br />Revised: 10-18-16 <br />