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City of Santa Ana <br />' `q Clerk of the Council <br />E) <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amendments (if any) are no longer in effect.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 —Z <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />rCOTC Office Use Onlv <br />The agreement with re /M t48 0I ; JdyY )g <br />No. N-2021-089 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: CDA , kA5 �Ib�t-I'(L{e- <br />Phone/Ext.:Cj","�j (S�Cj rj <br />Signature: <br />Date: _ i—j_2,0 i 9�i 1 <br />iaagreemenislformslform- agreemeniterminalionform_goldenrod.doc `� 1� <br />