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City of Santa Ana <br />'�%•�t Clerk of the Council CO7C Office Use Only <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amendments (if any) are no longer in effect.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 _-qLEPKIBF COUNCIL <br />Return form to the Clerk of the Council Office (M-30). <br />INC1v v ' 1 Pw rev <br />Call 647-1520 if you have any questions. <br />The agreement with 4 kw& A tko\q <br />No. N-2019-075 was completed on 0&120lX2() and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: -M551i <br />Phone/Ext.: rot -in <br />Signature: <br />Date: W n Ica <br />Revised: 10-18-16 <br />M1� <br />