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City of Santa Ana <br />'--f Clerk of the Council <br />1- <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amendments (if any) are no longer in effect.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 Olflce Use Only <br />,„.T4E <br />c v;05- <br />The agreement with Vpl rN" FOYYP_�Sli <br />No. N-2021-116 was completed on tol W I 4ALi and final payment has been made. <br />(List all amendments. Use space below if needed.) �" <br />Department: �/ f�( -5 Cul�'dlC,/ <br />Phone/Ext.: <br />Signature: <br />i:lagreemenlslformslform -agreement termination form_goltlenrod.doc Date: <br />