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City of Santa Ana V� <br />�t Clerk of the Council coTCOffice Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and J <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amendments (if any) are no longer in effect.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 of Santa Ana <br />have been satisfied prior to signing the termination form. ✓ AUG 0 2 2021 <br />Is the agreement(s) a permanent record? Yes_ No <br />Clerk of the Council <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. ^I <br />The agreement with 17 — E M 1,0, 9CA&eM <br />N-2018-055 <br />No. was completed on 4I an►R and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: MS i <br />Phone/Ext.: !,{;2iq <br />Signature: <br />Date: 91 l ) o` cO <br />Revised: 10-18-16 <br />