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City of Santa "na COM Office Use Only <br />Clerk of the Coy,. fcil <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amendments (if any) are no longer in effect. City of Santa Ana <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)apermanent record? Yes _ No Clerk ofthe Council <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 0 l.(1 <br />N-2020-041 <br />No. was completed on I�2 and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: <br />Phone/Ext.: ((ll <br />Signature:a <br />Date: �7IM �Di) <br />i9agreementslformsVorm -agreement termination form_goldenrod.doc <br />