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r City of Santa Ana <br />Clerk of the Council i COTC ON Ice Use Only <br />I--------- ------ ---------------------- <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amendments (if any) are no longer in effect.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 />City of Santa Ana <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. a , 21 <br />Is the agreement(s)apermanent record? Yes _ No Clerkot'the Council <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 ��A1A A Cl Rez, <br />No N-2019-177 was completed on 91 IV I and final payment has been made. <br />(List all amendments. Use space below if needed.) �j <br />Department: <br />Phone/Exf.: J'7 <br />Signature: w iV a n <br />Date: % 1,24-1-1 <br />Revised: 10-18-16 <br />