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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 al <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amendments (if any) are no longer in effect.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 />s 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 />1 <br />No. C'' zz- wA was completed on ' <br />'List all amendments. Use space below if needed.) <br />Department. <br />Phone/Ext.: <br />Signature: <br />Date: <br />0agreementslformsbrm - agreement termination formagoldenrod.doc <br />COTC Office Ilse QnIl <br />CL <br />City of Santa <br />JAN 11 2024 <br />Gierk s, Office <br />and final payment has been made. <br />