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City of Santa ." na <br />Clerk of the Cou..cil <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amendments (if any) are no longer in effect.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 <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 ar m `.••"" <br />A-2015-096-01 <br />No. _ was completed on <br />(List all amendments. Use space below if needed.) <br />Revised: 16-18-16 <br />r <br />���i il�Ili • • <br />COTC Office Use Only <br />City of Santa Ana <br />0 2 2021 <br />Clerk of the Council <br />has been made. <br />Department: �K L�Ttl 1Nl i� L,r <br />Phone/Ext.: <br />Signature:x <br />Date: <br />