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0City of Santa Ana <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 />COTC Office Use Oniv/ <br />City of Santa Ana <br />AU3 02 2021 <br />Clerk of the Council <br />The agreement with voS -1' <br />No. �) - 20 ) - i r, was completed on C1 j51 aZCi and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: 'FP-0—�4A" <br />Phone/Ext.: 5DL ' <br />Signature: as Q A� k ,CA)QAj(1 n <br />Date: DIGC7 <br />hagreemenlsWorms4orm - agreement termination form_goldenrod.doc <br />