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City of Santa ! 7 <br />Clerk of the Council <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amendments (if any) are no longer in effect. City of Santa Ana <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. r vn <br />P g s k.u.3 02 2621 <br />Is the agreement(s) a permanent record? Yes _ No Clerk of the COun ;l <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 �9-TL l o&c a�Q n <br />No. A 0 k(C was completed on /201.0 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.:C( <br />Signature:`c <br />Date: W%6ja <br />Revised: 10-18-16 <br />