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ip,_ City of Santa Ana <br /> ' i 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 amendments (if any) are no longer in effect.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 /> • <br /> The agreement with a/U.7V ?Ite <br /> . <br /> j, ,2od 7-(56 �v;No. 7 was completed on �:/c-' /<'/ and final payment has been made. <br /> (List all amendments. Use space below if needed.) l-; <br /> pe.... 1 <br /> r 02 d 0 p - t O ? Department: GV/' r <br /> - s <br /> // ( A &eve/ralP, Phone/Ext.: i <br /> r —fo2a ^ op <br /> ark <br /> 1.. <br /> r l - Signature: <br /> rQQ Atli), fl"" Ass—of „...._ <br /> Date: 7 l3/17 <br /> Revised: 10-18-16 /4 w /4 - /lO <br />