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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amendments (if any) are no longer in effect.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 />Nate: 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 />1 <br />GOTC office Use O lv <br />C 2D23 <br />City of Santa Aria <br />JAN 11 2024 <br />city Clark,.; OfiCE! <br />No. - N-202-3-103 was completed on S j U 173 and final payment has been made. <br />(List all amendments. <br />Use space below if needed.) <br />Department:' <br />Phone/Ext.: 9 <br />Signature: <br />Date: <br />iAagreementsVormsVorm - agreement termination form —golden rod. doc <br />