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City of Santa Ana <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amendments (if any) are no longer in effect.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 E <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 Law <br />No. - N-2018-109 was completed on M ;twhols_ and final payment Y <br />went has been made. <br />(List all amendments. Use space below if needed <br />Department: MeA <br />Phone/Ext.: <br />Signature:c� hie <br />Date: Ix lob 1201 k <br />Revised: 14-18-16 <br />