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City of Santa Ana cOTC office Use On[ <br />� Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />City of Santa Ana <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in 2021, <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. ityeP'k'S Office <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-34). <br />Call 647-1520 if you have any questions. <br />The agreement withAmwieetnArk <br />N-2022-052 <br />No. - was completed one,.:'' <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />lagreementslformsVarm - agreement termination form_goldenrod.doc <br />e Ial;ar CvmLh� <br />and final payment has been made. <br />�i n <br />IG . .151- <br />