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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amendments (if any) are no longer in effect.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 />Is the agreement(s) a per-manent 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 C0MM)UA R � w 0 <br />a. A-2022-092-1 was completed on <br />(List all amendments. Use space below if needed., <br />Department: <br />COTC Office Use Qni <br />City of Santa Aria. <br />JAN 112024 <br />pity Clerk's Office <br />and final payment has been made. <br />Phone/Ext.: <br />Signature: <br />Date: 451 <br />tagreements\formsbrm - agreement termination iorm_g©ldenrod.doc <br />