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0City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />Please complete this form in its entirety when the attached agreemenmj 22 PH !!' % <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amendments (if any) are no longer in effect.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 IT Y OF S A H TA ANA <br />have been satisfied prior to signing the termination form. CLERK OF COUNCIL <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 />No. N-2016-170 was on completed 11 <br />p / oZDl and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PRGEj A <br />Phone/Ext.: Li , lo\ <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />