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City of Santa Ana <br />__ ---- <br />_le%-,t Clerk of the Council COTC Office Use Only <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amendments (if any) are no longer in effect. Za'� air 22 �• 0 <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF SAf3TA AAA <br />have been satisfied prior to signing the termination form. CLERK OF COt1ldCll <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 />MMMMENWEido <br />The agreement with LJ <br />No. N-2017-081 was completed on E/ j'D-0►`h and final payment has been made. <br />(List all amendments. Use space below if needed.) Department: PR C 6A <br />Phone/Ext.: slam. <br />Signature: Qq �-- <br />Date: R&oa hnola <br />Revised: 10-18-16 <br />