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City of Santa Ana <br />-1 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amendments (if any) are no longer in effect.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 retard? Yes i No�- <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The anrpPmPnt with <br />COTC Office Use Only <br />0 <br />A-2019-094-195 <br />No. was completed on and final payment has been made. <br />(List all ornendmenfs. Use space below if needed.) <br />Department: �. <br />Phone/I <br />Signatu <br />Date: <br />Revised: 10-18-16 <br />