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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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />The agreement with <br />No. N-2021-088 was completed on (P and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: CDI) ! bfb (uA+Lla& <br />Phone/Ext.: t�je Q( 53r45r, <br />Signature: l Aut1M lQ�x_ <br />Date: 7 D'7 <br />ilagreementsWorms\form - agreement termination form_goldenrod,one <br />