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City of Santa Ana <br /> '. Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entiretywhen the attached agreement and all �t ' 5•5 <br /> p g ��)� JUL � � �.� <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements ! t-i <br /> have been satisfiedprior to signing the termination form. f } . <br /> 9 9 - - <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 /> The agreement with �fV)( 1��1( LAvt)< <br /> No. -3 -0` was completed on 3)3) I 1 S7 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: <br /> Phone/Ext.: iI (�(9 9-- //'t <br /> Signature: s.A. v— G' V A <br /> Date: -13�i'� <br /> Revised: 10-18-16 <br />