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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amendments (if any) are no longer in effect.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 />{dote- 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 A—)CtjcL L v 1 5 Y 0- <br />COTC Office Use On] <br />c 2,02,2-- <br />City ()f Santa AnS <br />JAN 112024 <br />citycierWs Office <br />No. <br />N-2022-045 was completed on V�- and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department:' <br />Phone/Ext.: <br />Signature: <br />Date: 1 2,3 <br />iflagreementslformslform - agreement termination form_goldenrod.doc <br />