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City of Santa Ana <br />-r Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />(�)J�ag <br />COTC Office Use Only <br />CLERK OF THE COUNCIL <br />JAN 31123 Pwa:58 <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amendments (if any) are no longer in effect.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 agreement with / f -'; t, s /-K <br />No. A-2020-043-12 was completed on q',?0�0';I and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />r: agreementn;Vormslform - agreement termination form_goldenrod.doc <br />