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16 _, <br />City of Santa Ana <br />As-t ;:_.. <br />-; <br />F °,a <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amendments (if any) are no longer in effect.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 L,7� <br />A-2016-377-03 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />2olin 3 77 - a / <br />i:kagreemenlsVormsUorm-agreement termination form_goldenrod.doc <br />G /V <br />COTC Office Use Only <br />City of Santa Ana <br />JUN 2 3 2021 <br />Clerk of the Council <br />7 h 170? 0 and final payment has been made. <br />Department: r L. bb& G(1o4 5 >"fV/) cc/ <br />Phone/Ext.: <br />Signature: \ <br />Date: `/� 3 2 <br />