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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 al <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amendments (if any) are no longer in effect.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 farm to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office Use Only <br />C Z�Z,3 <br />CitV of Sam Aw <br />City Clerk's Cfte <br />The agreement with <br />A-2022-092-04 <br />No. was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department, JA- <br />Phone/Ext.: <br />Signature: <br />Date: l <br />hagreemenlslformslform - agreement termination form—golden rod, doc ` <br />