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City of Santa Ana <br />Clerk of the Council �NI COTC Office Use <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amendments (if any) are no longer in effect.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 />CLERK OF THE C€fUNCIL <br />Note: If your agreement is grant related, please ensure that all grant retention requirements MCI aS i2? AQ: 42 <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). <br />Call 647-1520 if you have any questions. <br />The agreement with L � 1/1 VieA <br />No. N-2019-131 was completed on L::;'-C and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: Mc� <br />Phone/Ext.: '2 <br />Signature: �- <br />Date: g �� <br />Revised: 10-18-16 <br />