Laserfiche WebLink
City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <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amendments (if any) are no longer in effect.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 />Use <br />pr, 22 FM 4: 04 <br />EOF SANTA AN <br />R OF COUNCIL <br />No. <br />N-2016-184 was completed on W,3I Ll and final payment has been made. <br />(List all amendments. Use space below if needed.) n� <br />Department:'�j �l Yid Q n <br />Phone/Ext.: <br />Signature: <br />Date: -% L)l P, 119 <br />Revised: 10-I8-16 <br />