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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amendments (if any) are no longer in effect.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 />Nate: 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 (!rl'l-30). <br />Cali 647-1520 if you have any questions. <br />The agreement with _- D,0 k, - <br />No. N-2022-140 was completed on <br />(List all amendments. Use space below if neededj <br />Oagreernentslforms4orm - agreement termination form_goldenrod.doc <br />COTC Office Use Only <br />L <br />CI j^f7 , •/hr <br />~ V <br />JAM 112024 <br />City Clerk's Office <br />Wo and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />Li <br />k <br />