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City of Santa Ana `n`R _ <br />1J �% <br />Clerk of the Council COTC Office Use Only <br />.n ; a, <br />✓a� _ <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amendments (if any) are no longer in effect.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 _✓ SANTA ANA CITY CLERK <br />Return form to the Clerk of the Council Office (M-30). PAR 14'23u411:33 <br />Call 647-1520 if you have any questions. <br />The agreement with <br />X-7r(2 <br />A-2019-133 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />-`'i)and ilinal payment has been made. <br />Department: l--V <br />Phone/Ext.: 5 % <br />Signature: c <br />Date: 11 0� <br />Revised: 10-18-16 <br />