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City of Santa Ana COTC Office Use Only <br />Clerk of the Council <br />G2.0Z2 <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amendments (if any) are no longer in effect.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. E <br />Is the agreement(s) a permanent record? Yes No F, <br />Return form to the Clerk of the Council Office (NI-30) . <br />Call 647-1520 if you have any questions. <br />The agreement with <br />N-2022-359 <br />No. was completed on <br />(List all amendments. Use space below if needed,) <br />hagreementMformsVorm - agreement termination form_goidenrod.doe <br />{ i I -1zJ Z,2— and final payment has been made. <br />Department: / W 0"— C. fl <br />Phone/Ext.: <br />Signature: <br />Date: <br />g, [ L <br />,rA� _ <br />kI-zc�Iz <br />