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City of Santa A--i <br />j Clerk of the Coun-e --coTc office use only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and?Pa'IR y it 29 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITYI OF SA N 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 <br />A-2018-135-15A <br />No. _ was completed on s) and final payment has been made. <br />(Lis[ au amenaments. use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: /- <br />Date: <br />Revised: 10-18-16 <br />