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City of Santa Ana <br />City Clerk <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amendments (if any) are no longer in effect.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 City Clerk's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />N-2023-08 <br />No. was completed on�and final payment has been made. <br />(List all amendments. Use space below if needed.) / {1 � <br />Department: K \LUJ <br />Phone/Ext.: <br />Signature: __ I <br />Date: <br />COTC Office Use Only <br />City of Santa Ana <br />JUL 06 2023 <br />City Clerk's Office <br />dagreementsVormsVorm - agreement termination form_goldenrod.doc <br />