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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 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amendments (if any) are no longer in effect.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 />Use <br />orl 23 P11t 5: 30 <br />tY Or SANTA ANA <br />LEIRK OF COI'RM <br />The agreement with FRO P<L-rtA--- Lo1Js, Lx-rW b 64ioJP r-� <br />No. N , 1.017 y5 7 <br />, 3 was completed on t15 2-7- and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PJ/k <br />Phone/Ext.: 331 c' <br />Signature: ✓yip <br />Date: b�/�--- It <br />Revised: 10-18-16 <br />