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City of Santa Ana <br />Clerk of the Council COTC Office Use <br />----- ---- -- --- ---- --- <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />117 <br />amendments (if any) are no longer in effect. <br />C+gNote: If your agreement is grant related, please ensure that all grant retention requirements C' <br />1-CRF11 ur- <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 />17 1 17 A <br />The agreement with <br />No. N-2016-117 <br />(List all amendments. <br />Revised: 01-07-16 <br />C 20th <br />was completed on and final payment has been made. <br />Use space below if needed.) <br />Department: WZ15A <br />Phone/Ext.: 5-a-94 <br />Signature: E� lj A3 �A )D—AOO <br />Date: vu <br />