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0 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 and <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amendments (if any) are no longer in effect.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 />JUL 19 PM 3: R9 <br />SANTA ANA <br />OF COUNCIL <br />The agreement with n/a t1(- 12-cy, C'oC{-__- <br />No. N-2017-228 was completed on ICI and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: TW15-� <br />Phone/Ext.: <br />Signature: <br />�ioQAj C 1 l 11(r <br />Date: 1 J <br />Revised: 10-18-16 <br />