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City of Santa Ana <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 have <br />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 <br />COTC Office Use Only <br />2m4 AUG 21 Pit LI. 59 <br />CITY OF SANTA ANA <br />CLERK OF COUNCIL <br />No. N-2016-014 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department <br />Phone/Ext.: <br />Signature: (MJA,7%� i �-- <br />Date: �� IQ 208 <br />Revised: 01-07-16 <br />