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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 a <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amendments (if any) are no longer in effect.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 1 h I rit c <br />No. was completed on <br />(List allamendments. Use space below if needed.) <br />i agreementslformOarm - agreement termination form_goldenrod.doe <br />COTC Office Use Only_ <br />CZ02a <br />City of Santa Ails' - <br />City Clerk's OfficPi <br />g-lo - ,r�-2:;, and final payment has been made. <br />Department: 6 <br />-;2- <br />Phone/Ext.: 23- <br />Signature: <br />Date: 41 — a d- <br />