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r City of Santa Ana <br /> 7.r%r Clerk of the Council <br /> COTC Office Use Only <br /> I <br /> "" AGREEMENT TERMINATION FORM �� <br /> Please complete this form in its entirety when the attached agreement a+r.d aJ�,, <br /> amendments (if any) are no longer in effect. ' ,.".7! t 6 Pt'� 1: "I9 <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements >rt j . <br /> have been satisfied prior to signing the termination form. �t; ,� <br /> CLERK OF <br /> r�r�il �C�L <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 /> The agreement with `l- U VV\-ik.1 VCAt 4 A� 2 t&M'1 Q l 4,;. �C' 'viz c Q 1,C <br /> No. N-2019-098 was completed on 5131 i t9 and final payment has been made. <br /> (List all amendments. Use space below if needed.) 4 <br /> Department: V` .S A <br /> Phone/Ext.: j,..Sl <br /> Signature: )k-GL tAi1/4Q1Vi CV) <br /> Date: 1tT I L9 <br /> Revised: 10-18-16 <br />