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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amendments (if any) are no longer in effect.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 prior to signing the termination form, <br />s the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). <br />Cali 647-1520 if you have any questions. <br />The agreement with <br />k A <br />No. N _2 0 2 Z _ 16 6 was completed on <br />(List all amendments. Use space below if needed.) <br />P: agreements4ormsWorm - agreement termination form—goldenrod.doc <br />COTC Office Use Onl <br />L_ LO ?A, <br />City of Santa Are. <br />JAN 11 2024 <br />City Clerk's office <br />and final payment has been made. <br />Department: LA r1j? <br />Phone/Ext.: <br />Signature: <br />Date: <br />