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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amendments (if any) are no longer in effect.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 - =r - <br />le <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 />COTC Office Use Only <br />OF !HE <br />2'2 -"3- 7 `= <br />The agreement with "� s <br />r <br />No. N-2017-090 was completed on Qj and final payment has been made. <br />(List all amendments. Use space below if needed.) /� <br />Department: Mc sA <br />Phone/Ext.: <br />Signature: 11� iid, <br />Date: (` I cAo' <br />Revised- 10-13-15 <br />