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City of Santa Ana <br />Q;06e-:-'7 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amendments (if any) are no longer in effect.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 />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 />?- i �' V &� I <br />Ck <br />No. . N-2023-008 was completed on <br />(List all amendments. Use apace below if needed.) <br />AagreementsVormsVorm - agreement termination form—goldenrod.doc <br />COTC office Use oniy <br />c 2-c)-2-3 <br />City of Santa Aria <br />i 1ltl 13 and final payment has been made. <br />1/1 <br />Department: L01� (19 <br />Phone/Ext.: 52 0 <br />Signature: <br />Date: r -'`D <br />