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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amendments (if any) are no longer in effect.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 Nt,%4G P 06C) <br />COTC Office Use Only <br />flF THE COUNCIL <br />3 V'21 04tM ' <br />N-2021-003 <br />No. was completed on A f I and final payment has been made. <br />(List aff amendments. Use space below if needed.) <br />Department: Cog [/ kb '', C.lfAJ afk, <br />Phone/Ext.: '5355 0( 5355 <br />Signature: t �1 i1 Q��CAA066n4'L�' <br />Date: & 130 iso Ll <br />i.\agreememsVormslform -agreement termination form_goldenrod.doc <br />