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City of Santa R -a <br />Cleric of the Couki,,:il <br />cOTC Office Use Only <br />AGREEMENT TERMINATION FORM <br />�202-� <br />Please complete this form in its entirety when the attached agreement and all <br />City of Santa Ana <br />arnendnnents (it any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />uN021 <br />have been satisfied prior to sighing the termination form. <br />Clerk of the Council <br />Is the agreements) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 it you have any questions. <br />The agreement with <br />No. was completed on r 4and final payment has been made. <br />(List all a�ymeendments. Use space before if needed.) <br />t61 --q Department: <br />GL �L <br />Phone/Ext.: <br />24. -7 Signature: _.. <br />Date: 4 � ,Z -: <br />Revised: 10-18-16 <br />