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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amendments (if any) are no longer in effect.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 <br />COTC Office Use Only <br />No. N-2021-093 was completed on In 3D j ZbLt and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: CDA I Drib 3 Cu iUk'U <br />t r <br />Phone/Ext.: 5355- 5355 <br />Signature:1\*Q� l <br />Date: <br />agreements forms form agreement termination form_goldenmd.00c <br />