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0 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amendments (if any) are no longer in effect.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-2021-125 was completed on and final payment has been made. <br />(Lisf all amendments. Use space below if needed.) <br />Department: %� f" ICuJ V1AX'U <br />Phone/Ext.: 53% (7i 5355 <br />Signature: kMxajo'��iArr✓rV1DtA,J <br />Date: (0 i h� �2A <br />hagreementsiformt\form - agreement termination form_goldenrod.doc <br />