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-„ City of Santa Ana <br />*� City Clerk <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amendments (if any) are no longer in effect.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 farm. <br />Is the agreement(s) a permanent record? Yes No <br />$-- <br />Return form to the City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />COTC Office Use Only <br />C2102,3 <br />City of Santa Ana <br />JUL0 6 22 <br />City Clerk's Office <br />The agreement with[,�t <br />No, N-2023-078 was completed on 2 2 j and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: WG.5-A <br />Phone/Ext.: <br />Signature: 5,G <br />Date: (,ill <br />lAagreementslformsWorm - agreement termination form_goldenrod.doc <br />