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City of Santa Ana <br />Clerk of the Council COTC Office Use Only <br />......................... . ... ... <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amendments (if any) are no longer in effect.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 />C;tV 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. <br />i�3 0 2 ZU 21 <br />Is the agreement(s) a permanent record? Yes No <br />Clerk of the COLInCil <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 -�Ycu) -A\ yA \ALk.A, &V\ )Ck V�CUYW-� vlI,, � �i�WO "k4 <br />No. N-2019-106 was completed on -j1jcj'R0jq and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: MC5A <br />Phone/Ext.: q aP <br />Signature: <br />hs I' - <br />Date: 90 yo� <br />Revised: 100.18-16 <br />