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City of Santa Ana <br />Clerk of the Council coTc <br />-- ._... <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all I <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amendments (if any) are no longer in effect.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. =1,' <br />The agreement with , O 1 Memonaez <br />Na N-2019-092 was completed on 06130 h02Q and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: MCSA <br />Phone/Ext.: n1q <br />Signature: t--C�. <br />Date: 1\ 10 ► 12021 _ <br />Revised: 10-18-16 <br />