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; City of Santa Ana <br /> Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement and all ill ill <br /> l 3 1 i 3= 55 <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related, please ensure that all gr t retention requirements CITY OF S ,,+N ,<i r. <br /> have been satisfied prior to signing the termination form. c 5 Cl I_,,I 1 I <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 /> • <br /> The agreement with ?lu/a/c14-/z/ <br /> 1 <br /> N-2017-087 p ),� \ f ) payment No- was completed on and final a ment has been made. <br /> (List all amendments. Use space below if needed.) RWA-- <br /> Department: <br /> g' .7 l <br /> Phone/Ext.: �fd2 g j A <br /> Signature: <br /> ✓�fl <br /> Date: 71)) <br /> Revised: 10-18-16 <br />