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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amendments (if any) are no longer in effect.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 Cleric of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with <br />12ne <br />I\Qnk -16'- <br />N-2022-198 <br />{List all amendments. <br />was completed on <br />Use spare below if needed.) <br />Department: A <br />Phone/Ext.: <br />Signature: <br />COTC office Use Only <br />c 2022 <br />City of Santa Ana <br />City CicrWs Office <br />and final payment has been made. <br />