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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />2020 �ES -6 <br />Please complete this form in its entirety when the attached agreemen and all <br />amendments (if any) are no longer in effect. CITY OF SA <br />Note: If your agreement is grant related, please ensure that all grant retention requiremo,LsERK OF <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 />COTC Office Use Only <br />4* 22 <br />TA ANA <br />DUNCIL <br />The agreement with D(-X J t b <br />No. N-2018-054 was completed on Ll IM; �R and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: YLc)A <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />