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City of Santa Ana <br />'�- Clerk of the Cc .cil <br />AGREEMENT TERMINATION FORM J ` 10-6 <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. r <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 Only <br />F T 1170g�l_NCIL <br />11 '22AA-0, <br />N-2022-296 <br />No. was completed on D' �[ ' and final payment has been made. <br />(List all amendments. Use space below it needed.) <br />Department:] C� <br />Phone/Ext.: �b5� <br />Signature: <br />Date: 0/1C) <br />iiagreemen[Oorms\fam - agreement termination form_goldenrod.doc <br />