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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amendments (if any) are no longer in effect.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 />q <br />The agreement with <br />COTC Office Use <br />ILIL 19 PN ?: 116 <br />CITE' Or SANTA ANA <br />CLERK OF COUNCIL <br />No. N-2018-057 was completed on t and final payment has been made. <br />(List all amendments. Use space below it needed.) <br />Department: t51r <br />Phone/Ext.: `S <br />Signature: <br />Date: S1 I51( <br />Revised: 10-18-16 <br />