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City of Santa Ana COTC Office Use Only <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM \ \✓ 6" <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. CLERK OF T"l: COUNCB` <br />Note: If your agreement is grant related, please ensure that all grant retention requirements JAiN 3)-'23 PM3:59 <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 V ) r)M e? � /Z5 <br />A-2020-067-02 <br />No. was completed on <br />(List all amendments. Use space below N needed.) <br />hagreements\formslform - agreement termination form_goldenrod.doc <br />d,;i— and final payment has been made. <br />Department: <br />Phone/Ext.: ) ) <br />Signature: <br />Date: <br />