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City of Santa Ana <br />i 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amendments (if any) are no longer in effect.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 Na <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 />No. N-2023-012 was completed on <br />(List all amendments. Use space below if needed.) <br />Department:+' <br />COTC Office Use Onl <br />C2.02Z <br />ify of Santa ,ins <br />city clerk's Office <br />and final payment has been made. <br />Phone/Ext.- <br />Signature: 9-WA� <br />Date: _ - <br />bagreementslt`ormsVorm - agreement termination torm—goldenrod.d©c <br />