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City of Santa Ana <br />Via- t 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amendments (if any) are no longer in effect.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 __V_ <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 - V%0Aj A GU1 %elye7 <br />No. <br />COTC Office Use Only <br />rT <br />JF <br />r .,i ; pr:4re30 <br />N-2020-057 ,vas completed on �'213t 11(2 0 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: MCM <br />Phone/Ext.: %not <br />Signature: nj <br />Date: 01281202� <br />ilagreementstformsUorm -agreement termination form_goldenrod.doc <br />