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Date: <br /> Revised:10-18-16 <br /> City of Santa Ana <br /> . Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM 7019 J.E ri <br /> Please complete this form in its entirety when the attached agreement anc%6Tl OF SANTA ANA <br /> amendments (if any) are no longer in effect. C"RK OF COUNCIL <br /> Note: It 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 it you have any questions. <br /> The agreement with Se., Galt V, Ind.lan €niter <br /> No. A - 200% Z 31 was completed on Co t& 'MID and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: CD A /(,J0t Cesvivt <br /> Phone/Ext.: K ttt.o <br /> /c�br Z <br /> Signature: <br /> //G <br /> Date: ?- 1a-2o19 <br /> Revised:10-1 a-16 <br />