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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amendments (if any) are no longer in effect.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 />/ C/ <br />No. j�] � dVA �� — (��o / was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />COTC Office Use Only <br />I7IE T ME COUNCIL <br />12312= AmO:4 a <br />and final <br />payment hasbeenmade. <br />t,h�go�ti Eju-�vr�J <br />g— & d IN <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />