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City of Santa Ana ��� V� COTC Office Use Only <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amendments (if any) are no longer in effect.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 />CL K OF THE CI)i4t,lCI! <br />Is the agreement(s) a permanent record? YesEl No Z✓ 11 13'22 Rw8'.4� <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 />BUILDING CODE SERVICES INC. <br />No. A-2019-199-04 was completed on 51 131 Z1 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: Planning and Building <br />Phone/Ext.: X2717 <br />Signature: <br />Date: 07/12/2022 <br />i.�agreementsVormsVcrm - agreement termination m m_goldenrod.doc <br />