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City of Santa ! a <br />Clerk of the Council COTC Office Use Only <br />-- ---- <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all 9 Pil 12 <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amendments (if any) are no longer in effect.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 S AN TA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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 �la��1r1t>l� <br />N-2018-131 <br />No. was completed on (, and final payment has been made. <br />(list all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: �� _4� I Cs <br />Date: l C) <br />Revised: 10-18-16 <br />