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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amendments (if any) are no longer in effect.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 farm to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with�e'4f='s16 <br />COTC Office Use Onl <br />C 2,02-,2- <br />lty of Santa Ana <br />JAN I I Z8Z4 <br />city Clerk7s, Ofcc <br />No. N-2022-034 was completed on � r`� and final payment has been made - <br />(List all amendments. Use space below it needed.) <br />Department: C' 0A <br />Phone/Ext.: <br />r. <br />Signature: Vt h R <br />t <br />Date: <br />'sagreementslormslform - agreement termination form goldenrod.doc <br />