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City of Santa Ana <br />..tip <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this farm 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amendments (if any) are no longer in effect.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 �-i d <br />N-2022-167 <br />No. was completed on <br />(List all amendments. Use space below if needed,) <br />iAagreementsbrmsbrm - agreement termination form—goldenrod.doc <br />COTC Office Use Oniv <br />G - 1,oZZ <br />city of Santa Ana <br />JAN 11 2024 <br />On Clerk's wee <br />( V?-- and final payment has been made. <br />Department: '"' <br />Phone/Ext.: <br />Signature: <br />Date:f rj�J <br />