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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 rill <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amendments (if any) are no longer in effect.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 (Nt-30). <br />Call 647-1.520 if you have any questions. <br />The agreement with <br />CQTC office Use only <br />C2_02,3 <br />caty of Santa Ana <br />i <br />JAN I 120 <br />City Clerk's Office <br />No. N-2023-056 <br />was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: lLg <br />Signature: <br />Date: 227 <br />hagreemenWformsVorm - agreement termination form _goldenrod,doc <br />