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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amendments (if any) are no longer in effect.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 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 />The agreement with byAInd -eGN6 s LLC-- <br />COTC Office Use On <br />OF ;HE COUNCIL <br />'1.'22P. 110o191 <br />N-2022-233 <br />No. was completed on �5 2$ 2 Z and final payment has been made. <br />(List alf amendments. Use space below N needed.) <br />Department:C�� <br />Phone/Ext.:�j� <br />Signature: <br />Date: <br />hagreementslforms\fonn - agreement termination form_goldenrod.doc <br />