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City of Santa Ana <br /> ti -H=-r�11 Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement and all <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 amendments (if any) are no longer in effect.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 /> • <br /> The agreement withNI/LW Cc , D IA---reAL,k. <br /> A-2019-094-09A q— / <br /> No. was completed on I 2� and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department.e4(2 A <br /> Phone/Ext.: (10.--C—& / <br /> Signature: Q — ( '� <br /> Date: 9-/ -2� <br /> Revised: 10-18-16 <br />