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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amendments (if any) are no longer in effect.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: [f 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 Nd <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 />7017 AUG 24 " 1 7 <br />CITY OF SAN TA, z <br />CLERK F OSINCHL <br />1s-153 U <br />No, f1-20 was completed on -Ly 1 R and final payment has been made. <br />(List a1! amendments. Use space below if neededa <br />Department: <br />Phone/Exf.:�� �� <br />Signature: <br />Date:' <br />Revised: 10-18-16 <br />.`0 <br />