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City of Santa Ana - <br /> �`' � Clerk of the Council -� � COTC Office Use Only <br /> ° AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreemebfi a-rdall ' <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 amendments (if any) are no longer in effect.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 /> The agreement with ?ite.aA ACC,CSS <br /> No. A-Z G((C-12r5 1 .I 2- was completed on 1-W-20 lgand final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: C-Q A <br /> Phone/Ext.: (p�(0 I <br /> Signature: <br /> Date: 1 ' �C^ l <br /> Revised:10-18-16 <br />