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City of Santa Ana <br />r Clerk of the Council COTC Office Use Only <br />........ <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amendments (if any) are no longer in effect.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 <br />have been satisfied prior to signing the termination form. <br />Is the agreement(s) a permanent record? Yes No CLERK OF THE M NCIL <br />AW 2 Pm-:2 <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-2017-OSR was completed on�_li� and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: PRC EA <br />Phone/Ext.: yalq <br />Signature: �t <br />Date: I /((b R IC, <br />Revised: 10-18-16 <br />