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City of Santa Ana <br />Y 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amendments (if any) are no longer in effect.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 />The agreement with Jlev\i�v( C V ICbQ UvYY��g <br />No N-2021-009 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: (,) is / A (}5 i l .t(,N,U & <br />Phone/Ext.: 5 3`615 v Cj3Ej5 <br />Signature: A 6 A -A Q L 4_. <br />Date: <br />iiagreementsVorm54orm-agreement termination form—goldenmfd.doc `�'���1 � <br />