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0�� City of Santa Ana <br />r Clerk of the Council <br />!. -r <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amendments (if any) are no longer in effect.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 />COTC Office Use Only <br />City of Santa ME <br />JAN I I ZOM <br />City Clerk's Office <br />The agreement with orw'� OV <br />A-2022-033-04 <br />No. was completed on ',).LD-j8 and final payment has been made. <br />(List all amendments. Use space below if needed ) <br />hagreementslformslform - agreement termination form_goldenrod,doc <br />Department: <br />Phone/Ext.: 5L�43 <br />Signature: ftA,-- <br />Date: li �l10�'23 <br />�� <br />