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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,aPo <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amendments (if any) are no longer in effect.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 I <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office Use Only <br />32-10 +;.M -3, [ V. <br />e moi✓ <br />The agreement with WPt'TC-f1- WISE: TO -V <br />No. M, 2oi-7 • D LM was completed on id 1-7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: FVJ& <br />Phone/Ext.:' [ i <br />Signature:�� — <br />Date: 19 %cdt i <br />Revised: 10-18-16 <br />