Laserfiche WebLink
qp City of Santa AnaG <br />Clerk of the Council core niece 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amendments (if any) are no longer in effect. -'-,'E Ate '- <br />o _ <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. C11 T i F S i4 T _, <br />CLERK n,, <br />t <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 />No. N -2o16_094 was completed on <br />(List all amendments. Use space below if needed.) <br />Department: <br />and final payment has been made. <br />Phone/Ext.: tr <br />Signature: 21IOw�i�J�f <br />Date: 9% <br />Revised: 01-07-16 <br />