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City 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amendments (if any) are no longer in effect.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 Only <br />The agreement with iLGYx Y� �OYYC� <br />No. N-2021-117 was completed on Zo2 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: C DA/ ki5 3 CM5 V- Cj <br />Phone/Ext.: !34 0( 5351ci <br />Signature: 4vatA�L& CU40M 0 A'Al I <br />Date: (Q`,30I ZOZA <br />'r�agreamen`sUonns\form-agreement termination form_goltlenrotl.tloc <br />