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City of Santa Ana <br />Clerk of the Council S <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amendments (if any) are no longer in effect.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 />Call 647-1520 if you have any questions. <br />COTC Office Use Only <br />ANR CM CLERK <br />14123AMl1:35 <br />The agreement with V f ah(V, CQvfWi jiff)- ttymol n P t+h WuS �✓iLi <br />No. A-2022-092-22 was completed on Z ZZ 2ZZ2and final payment has been made. <br />(List all amendments. Use space below if needed.) ,^ <br />Department:n� T <br />Phone/Ext.: �� I <br />Signature: t -� <br />Date: <br />iiagreemenls\form0orm - agreement termination form_galdenrod.doc <br />