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City of Santa Ana <br />City Clerk <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amendments (if any) are no longer in effect.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 City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />COTC Office Use Only <br />ANti CITY CLERK <br />20'23 Pm-4:30 <br />The agreement with Clkr/IAG hVlr� 7GtLi?if i�SSt�Uaf�4 gQ✓t%Q f�lr�GiT�CGttS�l(� <br />No. A-Zoli-Ion -O t was completed on J l!� � � and final payment has been made. <br />(List all amendments. Use space below N needed.) {� <br />Department: VDA <br />Phone/Ext.: <br />Signature: <br />Date: <br />i9agreementsVormsVorm-agreement termination form_goldenrod.doc <br />