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City of Santa Ana c. J I nG <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amendments (if any) are no longer in effect.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. / SAN' <br />Is the agreement(s) a permanent record? Yes— No h <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. A-2020-043-21 was completed on <br />(List all amendments. Use space below N needed.) <br />i:lagreementsWormslform- agreement termination form_goldenrod.doc <br />COTC Office Use Only <br />ANA CI a Y CLERK <br />! 14123 P..49:30 <br />((cy 12 Ka hi t 1 <br />�,)-and final payment has been made. <br />Department: C-le-j/ <br />Phone/Ext.: <br />Signature: <br />Date: <br />