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.^- City of.Santa Ana <br />`a Clerk of the Council coT o nice u: <br />AGREEMENT TERMINATION FORM <br />Y <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amendments (if any) are no longer in effect.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 i <br />have been satisfied prior to signing the termination form. <br />Is the agreement(s) a permanent record? Yes No <br />n <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-7520 if you have any questions. <br />The agreement with <br />No. Pt - 2013 • lwc f was completed on (a/3,�p J i-i and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PLJB ,tc we S <br />Phone/Ext.: I `1 <br />Signature: <br />Date: �f I 1-4. <br />Revised: 10-18-16 <br />