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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amendments (if any) are no longer in effect.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 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 C'G %Qlmkv <br />COTC Office Use t7nl <br />C,2.,C)2;2,- <br />Cjjyof Santa An <br />ni er C's of <br />ice <br />N-2022-071 <br />No. - was completed on 21 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: C. <br />Phone/Ext.: P1 ,_ <br />Signature: <br />Date.- ? <br />iAagreementsiformsVorm - agreement termination form—goldenrod.doc <br />