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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agree!rrn pad <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requireCIiY OF S A <br />have been satisfied prior to signing the termination form. CLERK OF <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 awccmcnf Wifh Gain ") wl <br />A-2018-104 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />COTC Office Use <br />i <br />TA ANA <br />OUNCIL <br />TloqtlGra o W K i, <br />7 J/ kpoiq S /rvi -S . <br />/and�final paymentGhaass been made. <br />Department: <br />Phone/Ext.: /►�p�Z--,�p�, / <br />Signature: xl—�a�{�✓ <br />Date: U/�� <br />Revised: 10-18-16 <br />