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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amendments (if any) are no longer in effect.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 farm. <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-7 520 if you have any questions. <br />The agreement with QdvK, LeH <br />a <br />COTC Office Use Only <br />C ZOO <br />City of Santa ,A <br />JAN 11 2024 <br />City Clerk's Dace <br />No. _ was completed on 171�{ and final ,payment has been made.(Lisf all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />r <br />Date: <br />r: agreementstforms�form - agreement termination form—goldenrod.doc <br />