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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amendments (if any) are no longer in effect.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 X <br />Return form to the Cleric of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />N-2022-005 <br />COTC Office Use Only <br />C-Z,C) <br />Citv of Santa Ana <br />JAIL I 1 2D24 <br />City Clerk's Office <br />6 e� O(V-�Ct4 <br />No. _ was completed on ` and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature. <br />Date: <br />I: lagreement0ormsWorm - agreement termination form_golderrod.doe <br />CZ) 011) <br />