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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council Office (M-30). <br />C 200 5 <br />COTC Office Use Only <br />..~,. _ .., t ..,, E~: <br />a <br />_., <br />', ~c.~ .?k~i7~ ~ ~ CstD~d~~'~ <br />The agreement with Underwriters Laboratories, Inc <br />No. N-2004-129 was completed on 6/30/05 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Fire <br />Phone/Ext.: 714 647-5712 <br />Signature: <br />Date: 5/11/10 <br />Revised 04-12-10 <br />