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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form 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amendments (if any) are no longer in effect.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 />Return form to the Clerk of the Council Office (M -30) <br />Call 647 -1520 if you have any questions. <br />C <br />COTC Office Use Only <br />x- 4 <br />CITYa " <br />r <br />The agreement with sz <br />No. ; �2o 'V -2 7 was completed on _ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone /Ext.: <br />Signature: <br />Date: <br />Revised: 01 -07 -16 <br />