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City of Santa Ana 't;.N ]O� <br />Clerk of the Cour, 7 <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amendments (if any) are no longer in effect.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 VLE <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 eartwwa 5 <br />No. / was completed on <br />(List all amendments. Use space below N needed.) <br />COTC Office Use Only <br />OF THE COUNCIL <br />' 23 522 Am9:20 <br />9 h0 a-i and final payment has been made. <br />Department: PKcsA <br />Phone/Ext.: <br />Signature: <br />Date: <br />G <br />Revised: 1 Q 1 & 16 <br />