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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amendments of any) are no longer in effect.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 <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-2017-058 was completed on <br />(List all a-mendments. Use space below if needed.) <br />Revised. 10-18-16 <br />................................................... <br />COTC office Use only <br />2-O <br />X OF THE <br />V N.G b <br />and final payment has been made. <br />Department: Ce6 A <br />Phone/Ext.: AGE <br />Signature: <br />Date: <br />