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„r.. City of Santa Ana <br />'* 1 Clerk of the Council <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amendments (if any) are no longer in effect.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 />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 />?f'I” JUL 19 P"' 3: 116 <br />-ERKpOF" cQ NcNA <br />The agreement with icks0. JAem 1( (-W <br />No. N-2018-021 was completed on 1 and final payment has been made. <br />(List all amendments. Use space below ff needed) <br />Department: <br />Phone/Ext.: sals-z n <br />Signature: L� A ,L A( .J UO <br />Date: <br />Revised: 10-18-16 <br />