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City of Santa Ana COTC Office Use ON <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amendments (if any) are no longer in effect.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 />S-A <br />Note- If your agreement is grant related, please ensure that all grant retention requirements <br />-R 24 <br />P 4:_;i5 <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 <br />03r-1 <br />A-2022-033-02 \j <br />No. was completed on alaslqgA3 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: CA4 Hand S- <br />Phone/Ext.: <br />Signature: <br />L-le <br />Date: .�t�.9/a-3 <br />iitagreementsVormsbrm - agreement termination form—goldenrod.dOG <br />