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r City of Santa Ana <br /> .* i- Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> f [ <br /> Please complete this form in its entirety when the attached agreemag(la al.' P l 3: 18 <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related,please ensure that all grant retention requirement u ' 4 A N TA A NA <br /> have been satisfied prior to signing the termination form. i,L E OF <br /> r + 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 t `D\ \A, 0-k, v\ \`'L.G.VILk 4�'L -" La_ . <br /> _s J i r-,M1 <br /> N-2019-023 ,9y <br /> No. was completed on 14-7..` i ) ) C`I and final payment has been made. <br /> (List all amendments. Use space below if needed.) I f' <br /> Department: 9-LP f v t i ; , :3 <br /> .,' <br /> Phone/Ext.: <br /> Signature: S ), Q11:k'C��11PA,i(I\. --) <br /> Date: <br /> i1 1 b-U^ <br /> Revised:10-18-16 <br />