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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM SA �NT <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amendments (if any) are no longer in effect.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 Cleric of the Council Office (NI-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />N-2022-067 <br />No. <br />(List all amendments. <br />L- C*tvwt, LL <br />was completed on <br />Use space below if needed.) <br />iAagreementsWormslform - agreement termination brm_goldenrod.doc <br />COTC Office Use Only <br />C 0 12- <br />1-14 10 and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />