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r✓ <br /> City of Santa Ana <br /> Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement c a9 1PR ?LI PH 3: ! <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 amendments (if any) are no longer in effect.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 O S A N TA A HA <br /> have been satisfied prior to signing the termination form. CLERK1 O C OUNCilL <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 r� Uke Oki '\.('k.j G' '_%' <br /> No. N-2019-122 was completed on 1 12? I 1.c.1 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> ` ri <br /> Department: �l�`� �' <br /> Phone/Ext.: 9 .5i <br /> Signature: 'n;,c J k" D <br /> Date: - l : I [Cl <br /> Revised: 10-18-16 <br />