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City of Santa Ana <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amendments (if any) are no longer in effect.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. CL E" <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 />COTC Office Use ON <br />OF THE COUNCIL <br />L 6121 PM2:53 <br />The agreement with n U t I r <br />No. n— nil &.49c) was completed on Z I and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />�krGNcn - A " wn -3wo- cI <br />iAagreemenlslformeRorm- agreement termination form_goldenrod.doe <br />Department:�V1 111xbvu l <br />Phone/Ext.: <br />Signature: <br />Date: <br />