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r City of Santa Ana <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 <br />A-2015-048-02 <br />No. zis completed on / �1 <br />(List all amendments. Use space below N needed.) <br />Department: <br />Use Only <br />and final payment has been made. <br />Phone/Ext.: L 6/3 <br />Signature: <br />Date: 3 <br />Revised: 10-18-I6 <br />