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City of Santa Ana <br />Clerk of the COUk..-ll <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement a <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements I <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 />N-2017-127 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />COTC Off ice Use Only <br />19 M4 3: 118 <br />F SANTA ANA <br />OF COUNCIL <br />and final payment has been made. <br />Department: <br />Phone/Ext.: <br />S� <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />