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City of Santa / a <br />>•p C <br />�r Clerk of the Council OTC Office Use Only <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amendments (if any) are no longer in effect. City of Santa Ana <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.ALIG 0 2 261 <br />Is the agreement(s) a permanent record? Yes No <br />Clerk of the Council <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�lac� 1 i� <br />No. N-2017-107 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: �,S-L� <br />Signature: 0 r`J��yL �_ )-e-sm <br />Date: % 1d � I�ai <br />Revised: 10-18-16 <br />