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City of Santa Ana <br />Clerk of the Council i cOTc Office Use Only <br />4 ..... <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amendments (if any) are no longer in effect.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 j t <br />have been satisfied prior to signing the termination form. o <br />Is the agreement(s) a permanent record? Yes No <br />a <br />i.J <br />Return form to the Clerk of the Council Office (M-30). _ <br />Call 647-1520 if you have any questions. I tin <br />The agreement with GLA-VP-A- &0 <br />No. N' 2.0t'9 -2.L4 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: t?vJ& <br />Phone/Ext.: 031 c) <br />f <br />Signature: <br />Date: `f <br />Revised: 10-18-16 <br />