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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amendments (if any) are no longer in effect.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 <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 />N-2022-036 <br />No. <br />(List all amendments, <br />01 <br />was completed on <br />Use space below it needed.) <br />i:lagreementsiforms'+form - agreement termination form —golden rod. doc <br />COTC Office Use Only <br />Cr iI o Z—L <br />City of Sang Ana. <br />City Clerk's Office <br />�✓ and final payment has been made. <br />Department: 'V <br />Phone/Ext.; <br />Signature: <br />Date: <br />