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City of Santa Ana I �� <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 />COTc <br />City of Santa Ana <br />AUu 02 2021 <br />Clerk of the Council <br />The agreement with �1 6a.\1n C-�1 r <br />No. N-2019-170 was completed on Cl Id, Iq and final payment has been made. <br />(List all amendments. Use space below if needed.) rvt <br />Department: <br />rl Phone/Ext.: <br />P ✓Q( 1J Signature: lS/.1) kb&" 1�t1�/V WJ <br />5 l � <br />V�G, Date: -7 Ian <br />Revised: 10-18-16 <br />