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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amendments (if any) are no longer in effect.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. S4N <br />Is the agreement(s) a permanent record? Yes No X <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 />PN19 MY CLERK <br />14123 AM 11:34 <br />The agreement with W. AW-IFLES SMS%t LIMIM9 PA12TNIff-:- v, 010IA VMIWr4 <br />hl IKELESS <br />No. A - 2020 -Q9') W I4 was completed on 41'1 202 2 and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />agreementsformsform - agreement termination form_goldenrod.doc <br />Department: <br />rv4 A - toE-c. Eron- <br />Phone/Ext.: C1Ici)(o4l -5-403 <br />Signature: Ii <br />Date: b°1.14.2.022 <br />