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City of Santa Ana ` 0 Clerk of the Council o•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amendments (if any) are no longer in effect.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 />The agreement with <br />COTC Office Use Only ' <br />PNR CITY CLERK <br />' 21! '23 Ami-0:37 <br />No. <br />A-2021-068-086 was completed on 3 - �- 7j and final payment has been made. <br />Z 2 <br />(List all amendments. Use space below if needed) <br />Department: C <br />Phone/Ext.: <br />Signature: <br />Date: '21'Z3 <br />c5agreementsVorms\farm-agreement termination form—goldenrod.doc <br />