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. City of Santa Ana <br /> iire. 1 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 amendments (if any) are no longer in effect.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 C- .- <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 ci <br /> _7b‘f,`) ( kg&z. <br /> No. !!! <br /> / —.26 5-- l sJ( was completed on g/gAg and final payment has been made. <br /> (List all amendments. Use space below if needed.) F <br /> Department: px,9- <br /> begr <br /> Phone/Ext.: jj/i5 l' <br /> Signature: -1 ,- 0 T <br /> c5 <br /> Date: 2/7 18/) 1,1 <br /> Re,'sed. l i)-1 3-16 <br />