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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and al <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amendments (if any) are no longer in effect.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 />Cali 647-1520 if you have any questions_ <br />The agreement with <br />COTC office Use Only <br />C 20I (0 <br />No. N-201 G-142 was completed on jaL-7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department:; <br />Phone/Ext.: <br />Signature: <br />c <br />Date: ho jC <br />Revised: Q 1-07-16 <br />