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City of Santa t i <br />Clerk of the Council core office use only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all 1 <br />amendments (if any) are no longer in effect. Cih <br />Y 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.0 2 iP+11 <br />Is the agreement(s) a permanent record? Yes No _ Cierk of the <br />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 />No. A-2018-167 was completed on) and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: P Q-- P� I_ t A-�' <br />Phone/Ext.: <br />Signature: <br />Date: ? 13 <br />Revised: 10-18-16 <br />