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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amendments (if any) are no longer in effect.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 permanent record? Yes No <br />Return form to the Clerk of the Council Office (,M-30). <br />Cal! 647-1520 if you have any questions. <br />The agreement with <br />00 M frl 0'o (7 <br />1�et <br />COTC Office Use Onl <br />C 2-02-3 <br />�: ► of Santa Ana <br />JAN 11 2024 <br />c'erk's office <br />oc <br />No A-2022-092-1 8 p � and final payment has been made. <br />was completed on p y <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: -- `���1 - <br />Signature: J�!.r <br />Date: /,t- Ito <br />bagreementsVorms�forrn - agreement termination Form—goldenrod.doc <br />