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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />C 20(b <br />Office Use Ony <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect.(t <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CLEI' , <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 />No. N-2016-120 was completed on , qn and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: �BF'$LA. <br />Phone/Ext.: <br />Signature:�.l�l(y <br />Date: �1 <br />Revised: 01-07-16 <br />