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City of Santa P-a <br />Clerk of the Cou..-il <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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />City of Santa Ana <br />! 4 0 2 =s 1 <br />Clurt<of the Council <br />A-2019-172 <br />No. was completed on �� ^ and final payment has been made. <br />(List all amendments. Use space below if needed.) cc'' <br />Department: y� ����e�-�-L�/ �Y`(�11�, <br />Phone/Ext.: `�o2sl (� <br />Signature: E� ok 1Ck \ AN�//10 <br />Date: -7 L-7 d;l <br />Revised: 10-18-16 <br />