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M <br />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 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amendments (if any) are no longer in effect.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 farm. <br />Is the agreement(s) a permanent record? Yes No <br />r <br />Return form to the Clerk of the Council Office (M-30). <br />Coil 647-1520 if you have any questions. <br />The agreement with <br />COTC Office Use Only <br />C Zo 19 <br />HE C OUN01 <br />No. N-2019-069 was completed on 'r� fljq and final payment has been made. <br />(fist all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />Department: <br />Phone/Ext.: �[ <br />Signature: J�-- <br />Date: <br />