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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amendments (if any) are no longer in effect.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. <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 />The agreement with <br />No. A-2020-043-21 was completed on <br />(List all amendments. Use space below if needed.) <br />i1agreementslfonns\form- agreement termination form_goldenrod.doe <br />COTC Office Use Onlv <br />1NA CI, ; Y PLERK <br />)_41'23 Am9:30 <br />C�e� i`�CIVl r lC� <br />l <br />�,4-and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature:1�/ <br />Date:— <br />