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0 r City of Santa Ana <br /> �-�* <br /> Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement and all -0 t.77 -.: •ii <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements "C(T,`,f n 7 C;;" "•--f <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 /> The agreement with Lka C-6L91-4 1I 6 (psi)) <br /> No. A 2-61 S- C 74 was completed on , b// -/ and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: r — be- 719-71 <br /> Phone/Ext.: /` 0 <br /> Signature: 4/17j . O le <br /> Date: _454/? <br /> Revised: 10-18-16 <br />