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City of Santa Ana <br />Clerk of the Council <br />I <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amendments (if any) are no longer in effect.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 />The agreement with <br />COTC Office Use <br />SANTA ANA <br />OF COUNCIL <br />No. N'208-��r(0 was completed on v �� �b and final payment has been made. <br />(List all amendments. Use space below N needed.) Department: r �J <br />V—Q�A <br />Phone/Ext.: <br />Signature: eSk \� CAA A#IkCi <br />Date: 3fILl I Lii, <br />Revised: 1 n-1 & 16 <br />