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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amendments (if any) are no longer in effect.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 />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prier 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 \ f\Lam, '(A ",d\\ <br />COTC Office Use Only <br />C2-Q24- 2-- <br />City of Santa Ana <br />JAN 11 2024 <br />City ClerWs 'Office <br />No. N-2022-070 was completed on and final payment <br />a <br />p y has been made. <br />(List all amendments. Use space below if needed j <br />lAagreementsVormsVorm - agreement termination form—goldenrod.doc <br />Department: ( 0i <br />Phone/Ext.: <br />Signature: <br />Date: ,-_. <br />