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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement arol <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amendments (if any) are no longer in effect.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 forme <br />Is the agreement(s) a permanent record? Yes iNo — <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 />COTC Office Use Only <br />n i J Pi`1 12: 00 <br />,. <br />,Iiki <br />,isclL <br />/\( A,-2019-181 t�J <br />No. _ was completed on (�T and final payment has been made. <br />(Lisr an amendments. Use space below if needed.) <br />Department: <br />Phone/Ext. <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />the V1+s <br />