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{ City of Santa Ana coTC O#fice Use QnF <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amendments (if any) are no longer in effect. S - <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />JQL 12 <br />have been satisfied prior to signing the termination form, 4 P• <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 r-Q lop <br />No. N-2022-009 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;',agreementsforrnOorm . agreement termination form_goldenrod.doc <br />