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0,, City of Santa Ana <br />'° ' Clerk of the Co .cll <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amendments (if any) are no longer in effect.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 <br />COTC Office Use Onlv <br />FI"ME COUNCIL <br />1-1 . 2 FiW �g J <br />No. N-2022-295 was completed on ( and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: F (?LSA <br />Phone/Ext <br />Signature: ��Pv1 irs� <br />Date: 1 o/t O�a <br />is\agreementsWormslform- agreement termination form_goldenrod.doc <br />