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City of Santa Ana <br />f 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amendments (if any) are no longer in effect.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 agreements) a permanent record? Yes No ✓ <br />l <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 RCLI,P V- � - eS <br />No. N-2021-111 was completed on <br />(List all amendments. Use space below N needed.) <br />i8agreement0ormsform agreement terminall0d form goldenrod eoo <br />COTC Office Use Only <br />tol�Zi and final payment <br />rhas <br />,been made. <br />Department: CDA I {� 5 i �Gu�,b'd'c <br />Phone/Ext.: 15-M5 Vy 5355 <br />Signature: <br />Date: n 7 <br />