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" , City of Santa Ana <br /> Clerk of the Council COTC Office Use Only <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 amendments (if any) are no longer in effect.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 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 (YIN' wen au' 7 /ii / u'es Ali <br /> HeQgte <br /> No. A — 3 -t 22 was completed on ,' /!l / and final payment has been wide. <br /> p <br /> (List all amendments. Use space be if-needed. ! a1H belie/WA aCrO (Aaer <br /> 2063-622- eilea tV a 3 "003' 3/ ar'tment: l��A , IcatiA . <br /> M t'n/we* '-.2 3 -6 22 -01 Phone/Ext.: 0.97 <br /> fOA- <br /> eq3b —fib <br /> Signature: ' -�-• <br /> i Date: 41;0/ <br /> Revised: 10-18-16 <br />