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0 City of Santa Ana <br />Clerk of the Council coTc Office <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amendments (if any) are no longer in effect.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. <br />r, <br />Is the agreement(s) a permanent record? Yes No ✓ -- € t F CG -;"L`- <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 ACEruQ LenYn kni: <br />No. N-2017-257 was completed on t 1 I 'i1 201F3 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 1? i,Cf <br />Phone/Ext.: c--1lly <br />Signature:' <br />Date: oct wa, <br />Revised. 10-18-16 <br />