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, City of Santa Ana <br /> •a ' Clerk of the Council COTC Office Use Only <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 amendments (if any) are no longer in effect.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 /> 7118 Ill K ) c;l <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements (T OF w j ,; Alta. <br /> have been satisfied prior to signing the termination form. Ci <br /> f _ <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.ques,tions. <br /> The agreement with LVi{\A n, — <br /> s/?\ 1► �No. A—Zc� �S — Z- Q — `— as completed onand final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: {?� <br /> r r <br /> Phone/Ext.: j <br /> (67/1.7v,/ <br /> Signature: ,11,,A J <br /> Date: .� / 0)0C.7 <br /> Revised: 10-18-16 <br />