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�Y <br />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amendments (if any) are no longer in effect.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 —I--- <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 P610104. qC rV14V1CL +r . <br />COTC office Use Only <br />(J- LOLL <br />City of Santa Aria <br />City Clerk's Office <br />No. N-2022-017 was completed on e and final has been made. <br />payment <br />(List all amendments. Use space below if needed.) <br />!AagreemertslformMform - agreement termination form—goldenrod.dw <br />Department <br />Phone/Ext.: <br />L Opt <br />Signature: <br />Date: iT1 <br />