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City of Santa - -1a <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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />City of Santa Ana <br />'^ <br />U0 02 n <br />2IJ <br />Clerk of the Counu;l <br />The agreement with4(iYY <br />No. A-Y020-137 was completed on �31 /:)-o and final payment has been made. <br />(LW, ame :,nmenis. Use space below if needed.) <br />Department: lvd Mj1-L, I <br />Phone/Ext.: <br />Signature: ( OA— C"v-Q'Vy ) <br />Date: -% bg L;LA <br />i]agreementsVormsWorm- agreement termination form_goldenrod.dw <br />