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City of Santa Ana <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 i <br />amendments (if any) are no longer in effect. <br />i <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 />CXER t K OF THE COUNCIL <br />Is the agreement(s) a permanent record? Yes No _ AUG 2'21 PM3:31 <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any gquestions. <br />The agreement with �j y ► j���$�t((� to �Y�p ��p y <br />No. N-2019-142 was completed on %b t-p` [ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: S/A11(} 2 ' '�Wc,o <br />Date: % 1a9 1 W <br />Revised: 10-18-16 <br />