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City of Santa AnaC <br />__ _. <br />Clerk of the Council coTc ott�e u:e oni <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amendments (if any) are no longer in effect.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. f <br />1LA <br />Is the agreement(s) a permanent record? Yes No <br />V <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 />t <br />No. N-2017-187 was completed on Ir -j$Q (-j and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: `Pv\) A <br />Phone/Ext.: i <br />Signature: A!q��Zi L -el " <br />Date: i+ i L2-/11-7 <br />Revised <br />Z/1 - <br />Revised: 10.18-16 <br />