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�L City of Santa Ana <br />f City Clerk <br />�r Q <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amendments (if any) are no longer in effect.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 1 I <br />COTC Office Use Only <br />City of Santa Ana <br />JELL 06 2023 <br />City Clerk's Office <br />No. N-2023-101 was completed on �vl 2 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />iiagreementsVormsUorm- agreement termination form_goldenrod.doe <br />Department: lW, C i t � <br />-1 Phone/Ext.: T 11-7 <br />Signature: <br />Date:( �, <br />