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p <br />City of Santa Ana <br />III+*fit 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amendments (if any) are no longer in effect.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 />The agreement with <br />No. <br />chihwo 50no <br />r§a_a;. 5I <br />_. F, <br />N-2019-002 was completed on III 13A JJOVI ► and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: MC6F\ <br />Phone/Ext.: 5Ti A <br />Signature: �h <br />Date: it I %11102\ <br />Revised: 10-18-16 <br />