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City of Santa Ana <br />�1 Clerk of the Council <br />� AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement <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amendments (if any) are no longer in effect.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 / V/ <br />COTC Office Use Only <br />A-2018-202 <br />No. was completed on � 3 l � and final payment has been made. <br />(Lis. _.. ,..= ,pace below if needed.) <br />Department: -jDl� C--N�l' <br />Phone/Ext.: x <br />Signature: L/UO) /i f <br />Date: `�-/ <br />Revised: 10-I8-16 <br />