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City of Santa A <br />Clerk of the Council <br />vwt r <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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />Cl:'y of Santa Ana <br />t`.' 5 02 2u21 <br />Clerk of the Coun--il <br />No. /�V was completed on 1 t and final payment has been made. <br />(List all amendments. Use space below if needed.) �t c�� <br />Department: �1✓�J�- -P, A4yAtk ' <br />Phone/Ext.: 5-as-IL (l <br />Signature: Llko'tOk� A AA --'A 0 <br />Date: -7/aADLA <br />Revised: 10-18-16 <br />