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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amendments (if any) are no longer in effect.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 &eR vt - R6 / . <br />COTC Office Use Only <br />No. N-2021-092 was completed on Uj$8+,j and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />itagreementstforms\farm - agreement termination form—goldenrod.doc <br />Department: (; <br />r <br />Phone/Ext.: yJ3�rJ DiFj 3b5 <br />Signature: itiQ((u,0-1 <br />Date: ilp 1.7D7-i <br />