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City of Santa Ana <br />Clerk of the Council <br />AGR'FFAAENT TERMINAT1C7N 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amendments (if any) are no longer in effect.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 (M-30). <br />Calf 647-1520 if you have any questions. <br />I/C <br />The agreement with yU -> <br />022-155 was completed on *1 <br />1 <br />(List all amendments. Use space below if needed. <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />-+.anrpamentslformslform -agreement terminat+en form_goldenrod.doc <br />COTC Office Use only <br />U_,02�o� <br />city ct Santa. 4 <br />JAN 11 2021 <br />city GlerWsi►r;` <br />and final payment has been made. <br />