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: City of Santa Ana <br /> ; Clerk of the Council 1— COTC Office Use Only <br /> � "`°" AGREEMENT TERMINATION FORM <br /> • <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 amendments (if any) are no longer in effect.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 /> • <br /> • <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 <Yietneris fW/I Tehnelo ies (iiv, e s wsJ <br /> No. E7 -,21) v isk was completed on /.27q2MaRand final paym. nt has been made. <br /> (List all amendments. Use space below if needed.) C // "7/i(q2- V/ <br /> Department: f17 S1 13`,ti'leil- �_ e?411+ `. <br /> Phone/Ext.: X 4757 ii. o1/I <br /> Signature: 4.-,,S---An---- <br /> Date: ;1/6/ 6g <br /> Revised: I 0-18-16 <br />