Laserfiche WebLink
City of Santa Ana coTe Office use Only <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM C 2-0 Z2, <br />'lease complete this form in its entirety when the attached agreement and all,I, of San ��, <br />amendments (if any) are no longer in effect. <br />Nate: If your agreement is grant related, please ensure that all grant retention requirements JAM 11 2024 <br />have been satisfied prior to signing the termination form. <br />-"ity Uerk'sfr <br />Ps 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 I}I M\AtYP- _8vAjgY C �J f- q O(MODA <br />IV-2022-�J5f <br />No. - was completed on t, and final payment has been made. <br />(List all amendments. Use space below if needed) <br />Department: C D ll <br />Phone/Ext.: F i`] <br />Signature: C' <br />Date: "' <br />tagreementsVormslform - agreement termination form_goldenrod.doc <br />