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,., <br />City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />c .... <br />COTC ONice Use Only <br />Please complete this form when the attached agreement and all' - -S 97 s <br />amendments (if any) are no longer in effect. Y" <br />Note: If your agreement is grant related, please ensure that all grant retention requirements (j i v - <br />have been satisfied prior to signing the termination form. C1 <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-2016-123 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />lw and final payment has been made. <br />Department: V iA <br />Phone/Ext.: M <br />Signature: Sa Q 3,3i1 N kAAAO <br />Date: CA V�d � U <br />