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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amendments (if any) are no longer in effect.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 Oniv <br />No. N-2021-086 was completed on k 13D 1207,1 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />'rlagreementsl(ormsdarm- agreement termination form-goldenrod.doc <br />Department: CDA / P dtS ? CW4W & <br />Phone/Ext.: "5'7A5 o(G <br />Signature: V%.bX" <br />Date: V (Q�('j012o2► <br />