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City of Santa Ana <br /> • 4..z) : COTC Office Use Only <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 amendments (if any) are no longer in effect.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 /> • <br /> n //ig <br /> The agreement with t yli <br /> ,6,PA- <br /> No. fi-2C`G—"/� was completed on f13� 24,.% Sand final payment has been made. <br /> (List all amendments. Use s ace below if needed.) <br /> Department: (7 // <br /> Phone/Ext.: „ 4 <br /> Signature: ,:.a /7/ 5;14-,r0d17( _, <br /> Date: 2M// <br /> Revised:01-07-16 <br />