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Y City of Santa Ana <br /> 4e1 Clerk of the Council COTC Office Use Only <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form 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 amendments (if any) are no longer in effect.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 /> Return form to the Clerk of the Council Office (M-30). <br /> • <br /> Call 647-1520 if you have any questions. <br /> The agreement with Sou-Thzie.4.) l NL)/Arm (74,A),IZ <br /> No. / I '` 23 was completed on 6.�2eV)-5 and final payment has been made. <br /> (List all amendments. Use space below if needed.) �( <br /> Department: 672., <br /> 1/� <br /> Phone/Ext.: 031.2 / <br /> Signature: �i,..010,eed4 <br /> Date: Gl Vi7 <br /> Revised:01-07-16 <br />