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City of Santa Ana <br />_. Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Piease complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Nate: 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 />Cali 647-1520 if you have any questions. <br />COTC Office Use Onl <br />C ZoZ3 <br />City of Septa Arse <br />JAN 11 2024 <br />City Clerk's Office <br />The agreement with Me-,r�OVA-1 K)` Die <br />No. N-2022-328 was completed on � �] �� {� and final payment has been made. <br />(List a!1 amendments. Use space below if needed.) L-_Department: ' � 6 <br />Phone/Ext.: A <br />Signature: <br />Date: +a <br />iAagreementslformsVcrm - agreement termination form—goldenred.doc <br />