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City of Santa Ana <br />j Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this farm 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amendments (if any) are no longer in effect.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 647-3 520 if you have any questions. <br />COTC Office Use Only <br />(,- co?z <br />City of Santa Ana <br />City Clerk's Office <br />The agreement with L l , W1 % y k C <br />No.N-2Q23-QLI. was completed on rf� j' and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: lei <br />Phone/Ext.: <br />Signature: <br />Date: <br />r <br />