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'. City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />Please complete this form in its entirety when the attached agreeme"IfWft I Ili S; 0 I <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirementsC IT Y OF SAN TA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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 />N-2017-124 ) <br />No. was completed on O . t"` and final payment has been made. <br />(List off amendments. Use space below if needed.) /� <br />Department: PR C-S A <br />Phone/Ext.: q,2I��P, <br />Signature: <br />Date: Aon <br />Revised: 10-18-16 <br />