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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amendments (if any) are no longer in effect.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 />Dote: if your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prier 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 C U-tY-0 "aV <br />No.f� was completed on i l -Lf <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />COTC Office Use_On[vr <br />C l,2- <br />C+t of Santa A <br />JAN I 1 ZOU <br />City Ciark's Office <br />and final payment has been made. <br />Date: -1 L�1'1/2=11 <br />i lagreementsbrmsbrm - agreement termination form_goldenrod.doc <br />