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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amendments (if any) are no longer in effect.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 farm. <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 � 0Q v, m I <br />No. - was completed on <br />(List all amendments. Use space below if needed.) <br />iAagreementslformsVorm - agreement termination form _goldenrod.doo <br />COTC Office Use Only <br />C Zc2_3 <br />City of Santa Ane. <br />JAN 11 2024 <br />City Clerk's Cffte. <br />3 and final payment has been made. <br />Department: E <br />Phone/Ext.: <br />Signature: <br />Date: ":5--- D-7 <br />