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City of Santa P -j <br />Clerk of the Council COTC Office Use Only <br />l -... <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amendments (if any) are no longer in effect. City Of 2Ma 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.` 3 p 2, 2621 <br />Is the agreement(s) a permanent record? Yes No <br />i Clerk of 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 <br />N-2020-075 <br />No. was completed on ( and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: �/ f� <br />Signature: Cut (J� 1 a/'u (X/-) <br />Date: -71a7.�A <br />Revised: 10-18-I6 <br />