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r,_ City of Santa Ana _ _-.-.......__.__._-__...._ <br /> ~'rj COTC Office Use Only <br /> �'-=- ii. Clerk of the Council <br /> F° AGREEMENT TERMINATION FORM l7 <br /> E <br /> Please complete this form when the attached agreement and all ' _� Ay P i R76 p <br /> amendments (if any) are no longer in effect. fig i ,'' .. <br /> 5 <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements .,f €,. <br /> have been satisfied prior to signing the termination form. IT"(" i; ?� '.'. f P,f1. <br /> Return form to the Clerk of the Council Office (M-30). I 1 <br /> Call 647-1520 if you have any questions. , <br /> The agreement with i _1:11 fir'lU fq& fG/ J N( 6/ VICE- <br /> No. fi 's'7 was completed on t b- t " QC- and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department. <br /> Phone/Ext.: X C6(2 <br /> Signature: l TE/ <br /> )-44-rf <br /> Date: Z ie <br /> Revised:01-07-16 <br />