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w 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amendments (if any) are no longer in effect.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 Y <br />Return form to the Clerk of the Council Office (M-30). <br />Cal! 647-1520 if you have any questions. <br />The agreement with <br />COTG Office use Oni <br />C 2,c) 2,2_ <br />City of Santa Aria <br />JAN 11 2024 <br />City Clerk's Office <br />N-2022-004 <br />No. was completed on �' and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Aagreementslormslform - agreement termination form_goldenrod.doc <br />Department:i ' <br />Phone/Ext.: : <br />Signature: R- <br />Date:''' <br />