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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement anloi <br />amendments (if any) are no longer in effect. Lti� <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CI T <br />have been satisfied prior to signing the termination form. 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 />COTC Office Use Only <br />-6 PM LI: 23 <br />SANTA ANA <br />OF COUNCIL <br />The agreement with KA AD P�L 0ul A 1 ex-r [A t LA-0, <br />No. N-2017.180 was completed on ] and final payment has been made. <br />(List all amendments. Use space below if needed.) C !1 <br />Department: PRC�A <br />Phone/Ext.: 421Ok <br />Signature: I t/1�" ��vu✓ �i�,— <br />Date: gllelaon <br />Revised: 10-18-16 <br />