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°'• City of Santa Ana <br /> x47122) <br /> i-er Clerk of the Council I COTC Office Use Only �! <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 amendments (if any) are no longer in effect.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 /> The agreement with // & i]oIJAW, fir' <br /> No. A ;O/ 2 //`� was completed on and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: e,i <br /> lb7 <br /> Phone/Ext.: Z <br /> Signature: • 5 /�G/Tt/ <br /> Date: /0.4/7 <br /> Revised:01-07-16 <br />