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�.t.City of Santa Ana <br />.`It Clerk of the Council I dJ <br />:vim _ <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and <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amendments (if any) are no longer in effect.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 E1 No 7 <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 BUREAU VERITAS <br />COTC Office Use OnN <br />OF THE COUNCIL <br />"22 AMO'46 <br />NO <br />No. A-2019-199-05 was completed on P0me(It-." final payment has been made. <br />(List all amendments. Use space below if needed.) <br />U"cr Scrv1'c fs Inc Department: Planning and Building <br />('1Scci NC)pnyrnC(At-s <br />macic t-0 vurlcicr. <br />i:Wgwe ntMlormslform- agmemenl IeiminMon form —goldenrod doc <br />Phone/Ext.: X2717 <br />Signature: A V`^^AAJA9L <br />Date: 07/12/2022 <br />