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p 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amendments (if any) are no longer in effect.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 <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />C 2,011 <br />COTC Office Use C <br />The agreement with <br />No. AJ-,-16o9- <br />//r�V //y / / 17 was completed on and final payment has been made. <br />(List ali amendments. Use space below if needed.) �`�k'r 11 , <br />Department: <br />Phone/Ext.: <br />Signature: �y <br />Date: s 31t7 <br />Revisecl. 10-1 E 16 <br />