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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amendments (if any) are no longer in effect.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 __jLViK _ iA(( � <br />N-2021-006 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />i9agreementsVormslfarm-agreement termination form _goldenrod.doc <br />COTC Office Use Only <br />O3 i € E COS Iris£ <br />t rp °2 1r, 3;0'7 <br />WU and final payment has been made. <br />Department: CDA / Mbi cuat� L <br />Phone/Ext.: 53 <br />55 (0�( cjMGj <br />Signature: <br />Date: (Q 3d T07.A <br />