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City of Santa Ana <br />s COTC Office Use <br />Clerk of the Cour. <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreeme0,43nd1611 <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amendments (if any) are no longer in effect.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 <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 />L l-Ti Jr i S I_- L. C <br />No. k 201.4 • -S 51., - 01 was completed on I rLI and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PWX <br />Revised: 10-18-16 <br />Phone/Ext.: <br />331 `t <br />Signature: 1rX h <br />Date: 31 o- <br />