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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amendments (if any) are no longer in effect. i <br />Note: if your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination €arm <br />COTC Office Use Only <br />C 202 -� <br />lt,V of Beata Am' <br />City Clerk"$ <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 <br />No. _ was completed on <br />a st all amendments. Use space below d neededj <br />hagreementstformsVorm - agreement termination form_goldenrod.doc <br />yl <br />and final payment has been made. <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: �] <br />