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City of Santa Ana <br />Clerk of the Co- .cil <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amendments (if any) are no longer in effect.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 <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 �7("XJA WA <br />A-2017-35.Q-02 7i 2Zj i <br />No. was completed on and final payment has been made. <br />(List off amendments. Use space below if needed.) <br />_PW,+''nffi�l 6A b- VW(1440l <br />21 Le 1 zI <br />COTC Office Use Onlv <br />City of Santa Ana <br />JUL 01 MI <br />Clerk of the Council <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />iiagreementsVormslform- agreement termination form_pidenrod.doe <br />