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�.; City of Santa Ana <br />1 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amendments (if any) are no longer in effect.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 />The agreement with <br />COTC Office Use <br />AUG 21 PM 5-- 00 <br />ERK OFCOUNCIL <br />No. N-2016-074 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PR C �j <br />Phone/Ext.: �1nai� <br />Signature: [JY(q� GDA�iL <br />Date: q a01q <br />Revised: 01-07-16 <br />