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City of Santa Ana <br />>`jtit Clerk of the Cour <br />AGREEMENT TERMINATION FORM <br />COTC Office Use <br />Please complete this form in its entirety when the attached agreement all <br />amendments (if any) are no longer in effect. 2A 61 FW 4. 24 <br />Note: If your agreement is grant related, please ensure that all grant retention requiremeetT Y OF S N TA A N A <br />have been satisfied prior to signing the termination form. <br />s the agreementCLERK OFCOUNCIL <br />No s) a permanent record? Yes I <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 />No. N-2017-217 was completed on <br />(List all amendments. Use space below if needed.) <br />J Q I and final payment has been made. <br />Department: ; LQ%`Aij Ui7Yf-/y\,x <br />Phone/Ext.: j3LS- py <br />Signature: -,L� ,` A (zo <br />Date: ozm,; , <br />Revised: 10-18-16 <br />