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, „ City of Santa Ana <br /> Ado <br /> Clerk of the Council COTC Office Use Only <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 amendments (if any) are no longer in effect.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 <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 / /�C , /1 /z <br /> f <br /> �'�j �1 <br /> No. ��'"O "' /Dc2- was completed on / and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> / 66 y /O a - Q / Department: (Mt/ <br /> Phone/Ext.: J� <br /> c t6 o?8 Signature: <br /> Date: 1") f3/17 <br /> Re,,se,7. 1 13-16 <br />