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City of Santa Ana <br />�s t Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement arxii <br />amendments (if any) are no longer in effect. LL��''�� <br />Note: If your agreement is grant related, please ensure that all grant retention requirements l <br />have been satisfied prior to signing the termination form. CI T <br />CL <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-2017-126 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />COTC Office Use Only <br />21 PM 5-- ft I <br />SANTA ANA <br />OF COUNCIL <br />6 es and final payment has been made. <br />Department: —P—R—C— <br />Phone/Ext.: q,; Icj <br />Signature: (%WJ A! -- <br />Date: / ] �j lan iq <br />Revised: 10-18-16 <br />