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City of Santa Ana <br /> I �� 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 amendments (if any) are no longer in effect.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 /> Call 647-1520 if you have any questions. <br /> The agreement with ....52 ^17/3" 4)71- Aid 47 /7-7 <br /> No. A'ZD/ Z—/2(� was completed on llgv43 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: Obi* <br /> Phone/Ext.: a 2/ <br /> Signature: ,Q jm/9/ S/4 N 2 <br /> Date: G/2-41)//. <br /> Revised:01-07-16 <br />