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City of Santa Ana - U-- -- <br />COTC Office se Only <br />Clerk of the Council _.-_------------- ----.-.---- <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amendments (if any) are no longer in effect.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 />The agreement with <br />s.P <br />No. <br />Phone/Ext.: — - <br />Signature: Js U. 4(a C� <br />Date: <br />R,,,sed. 10-18-16 <br />