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City of Santa Ana <br />Clerk of the Council 66TC 6ffice <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement 22 (' 7 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY Q S ANTA ANA <br />have been satisfied prior to signing the termination form. CLERt of COU14CIL <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 <br />No. N-2016-190 was completed on ii <br />p � o Ia00 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />PRCE A <br />Phone/Ext.: <br />Signature: <br />Date: <br />ff <br />�3 140 0 1 Q <br />Revised: 10-18-16 <br />