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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 and all <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amendments (if any) are no longer in effect.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 />coTc office use oniy <br />101# SEP 27 Pti 3: 11 <br />CITY OF SANT'A/ ANA <br />ry <br />CLERK uF -n�i`ii 11 <br />The agreement with 2a0/A' ,� <br />N-2018-090 <br />No. was completed on lX '� "i{ and final payment has been made. <br />(List all amendments. Use space below if needed.) ��)) (\ p <br />Department: l 0A <br />Phone/Ext.: 5305 <br />Signature: l C,Lyyyy �'t <br />Date: Vg1:IMilb <br />Revised: 10.18-I b <br />