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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amendments (if any) are no longer in effect.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 L',i V► <br />N-2022-254 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />COTC Office Use Only <br />C2,(:)z:2- <br />Cjtv of Santa Ana <br />JAN 11 2024 <br />City Clerk's Office <br />r� <br />and final payment has been made. <br />Department: <br />tit <br />Phone/Ext.: <br />Signature: <br />Date:r�L! <br />