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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amendments (if any) are no longer in effect.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 V <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 <br />COTC Office Use Only <br />UY THE 010"INCt3 <br />N-2021-007 <br />No. was completed on A 31 12OZ4 and final payment has been made. <br />(List off amendments. Use space below if needed.) <br />iMagreementslformslform - agreement temnalion form_goldenrod.doc <br />Department: CIe,? /N({5 ��� <br />Phone/Ext.: ij,35i5 <br />Signature: gbt �1� <br />Date:y (b <br />