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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement land 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amendments (if any) are no longer in effect.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),I <br />Call 647-1520 if you have any questions. <br />The agreement with <br />COTC Office Use Only <br />1= T y, 11-IN <br />pil'2iapq <br />84 <br />N-2018-1 JKS <br />No. was completed on iZ'St 1?Qtq and final payment has been made. <br />(List aff amendments. Use space below if needed.) <br />Department: M15A, <br />Phone/Ext.: V)2-19 <br />Signature: �Y L <br />Date: 10 AA Z 002 <br />Revised: 10-18-16 <br />