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. , City of Santa Ana <br />Clerk of the Council COTC Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all ;r ag <br />y i <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY <br />have been satisfied prior to signing the termination form. f <br />Return form to the Clerk of the Council Office (M -30). <br />Call 647 -1520 if you have any questions. <br />Theagre,e¢mentwith <br />No. f[ / S — %if was completed on j [, and final payment has been made. <br />(List all amendments. Use space below if needed.) % 7 <br />Department: <br />Phone /Ext.: <br />Signature: <br />Date: <br />Revised[ 01 -07 -16 <br />