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City of Santa Ana <br />lilvk 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amendments (if any) are no longer in effect, 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- 7 520 if you have any questions. <br />The agreement with �UC' <br />N-2022-253 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />AL�2- <br />Department. <br />Phone/Ext.: <br />Signature: <br />Date: <br />CC]TC Office Use only <br />CzoZ <br />City of Santa Ana <br />JAN 11 2024 <br />City Clerk's Office <br />and final payment has been made. <br />Cat � <br />