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City of Santa Ana <br />Clerk of the Council '1 I �fn cLER I <br />AGREEMENT TERMINATION FORM JA <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amendments (if any) are no longer in effect.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. J <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 />No. <br />A-2021-068-08 was completed on <br />(List all amendments. Use space below ff needed.) <br />6agreememslfarms!form- agreement termination form_goldenrod.doc <br />Pic <br />COTC Office Use Only <br />31'23 Pt�3'58 <br />and final payment has been made. <br />Department: 610A <br />Phone/Ext.: toy L� I <br />Signature: OF <br />Date: 11 /m (2/7 <br />