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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC office Use Only <br />C2,03 <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Nate; If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. , <br />SI- <br />B A ANA C Tiy="LYE. K <br />Is the agreement(s) a permanent record? Yes No -Lila <br />Return form to the Clerk of the Council Office (M-30). E <br />Call 647-1520 if you have any questions. <br />The agreement with <br />No N-2017-094-03 was completed on <br />(List all amendments. Use space below if needed.) <br />02- <br />--0j <br />ctagreementsftrmsftrm - agreement termination form_goldenrod.doc <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />and final payment has been made. <br />LA 6 <br />S <br />