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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amendments (if any) are no longer in effect.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 />No. N-2015-175-001 was completed on <br />(List all amendments. Use space below if needed.) <br />COTC Office Use <br />M9 AlIG 22 I'M 01: t?b <br />OF SANTA ANA <br />RK OF COUNCIL <br />6- _ <br />iA�i l0 and final <br />payment has been made. n <br />Department: ? o — I's A <br />Phone/Ext.:a5 <br />Signature: 5 l )'oAf <br />Date:r� 1 �� <br />Revised: 10-18-16 <br />