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City of Santa Ana <br /> Clerk of the Council core Office bceOnly <br /> AGREEMENT TERMINATION FORM <br /> tli. -3 MI 9: 55 <br /> Please complete this form In Its entirety when the attached agreement ag17L, OF SANTAAN <br /> A <br /> (If any) are no longer In effect. II j OF COUNCIL <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 /> Is the agreement(s)a permanent record?Yes X No <br /> Return form to the Clerk of the Council Office (M-30). pp <br /> Call 647-15201f you have any questions. ±' <br /> The agreement with Transportation Studies, Inc'. <br /> No. A-2013-170-01 was completed on 10/31/15 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: PWA/Traffic <br /> Phone/Ext.: 5 6 06 <br /> Signature: <br /> Date: '1/2/19 <br /> Revised:10-1a-16 mm" <br /> Santa Anae Use Only <br /> City ofC Office Clerk of the Council cdr O-,.__._____.._,w_...___..__..-.._.-. <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in Its entirety when the attached agreement and glj <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 amendments (if any) are no longer in effect.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 /> Is the agreement(s)a permanent record?Yes No_ <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. was completed on and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: <br /> Phone/Ext.: <br /> Signature: <br /> Dote: <br /> Revised: 10-I6-I6 <br />