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City of Santa Ana <br />1 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amendments (if any) are no longer in effect. <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 />COTC Office Use Only <br />1018 3FP 27 PIMf 3: 1 I <br />CITY OF SANTA ,,V„ A <br />CLERK OF <br />The agreement with (,(/ & <br />N-2018-042 �r <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: QDA <br />Phone/Ext.: 5W5 <br />Signature: 6 <br />Date: "u9.9lie <br />Revised: l e-18-16 <br />