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ens. City of Santa Ana <br />Clerk of the Council COTC Office Use <br />_... — <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement anMgll A{!1. 7 Ei ,.I•, p, <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amendments (if any) are no longer in effect.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 t= Sc I; O' <br />have been satisfied prior to signing the termination form. CI-Ett C ; <br />i C C)i Pd <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-2018-135-20A <br />No. was completed on <br />(List an amendments. use space below if needed.) <br />(D-19 and final payment has been made. <br />Department: `✓UJA <br />Phone/Ext.: S <br />Signature: Date: 61) 3y 4 C <br />Revised: 10-18-16 <br />