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c 2017 <br />City of Santa Ana <br />......... .. ........ . ..................... ---------------- <br />Clerk of the Council COTC Office Use Only <br />........... .. .. ....... - --- .......... .. .. .. ............. . . .............. <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and CrT <br />amendments (if any) are no longer in effect. 23 P 93` - <br />Note: <br />3:Note: If your agreement is grant related, please ensure that all grant retention requirements C1 <br />TY n- F <br />have been safisfied prior to signing the termination form. r t QV f -I r <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 �-k r�YIVZ, i sem +LLQ <br />No. N-2017-181 was completed on q It, and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: P 9-(i%W <br />Phone/Ext.: <br />Signature: 'Z�Ql %I Ub "� <br />Date: to in In — <br />Revised: 1 G-18-16 <br />