Laserfiche WebLink
City 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 agreement and all it <br />amendments (if any) are no longer in effect. P17 MR, 22 PM 4: 07 <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. ;cirY OF SATA aNA <br />Is the agreement(s)apermanent record? Yes _ No CLERK OF COUNCIL <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-2016-186 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 10-18-16 <br />uWa6cl and final payment has been made. <br />Department: <br />PRe.rp A <br />Phone/Ext.: <br />San <br />Signature: <br />�Ji�ptA� �2 <br />Date: <br />p <br />p be I odd ka <br />