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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amendments (if any) are no longer in effect.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 />The agreement with Y Y? A vi Va di <br />COTC Office Use Only <br />cw2,L <br />City of Santa Ana <br />City Clerk's Office. <br />No. N-2022-020 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed) <br />Department: (� <br />Phone/Ext.: 5. 0 <br />� p _ <br />Signature: < <br />Date:,:, <br />i.lagreements4ormsVorm - agreement termination form_goldenrod.doe <br />