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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amendments (if any) are no longer in effect.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 />Mote: 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 />COTG Office Use Oniy <br />C2o23 <br />CRY Of Santa Ane, <br />JAN 11 2024 <br />City Clerk's office <br />tA� poaebvA s &Wshe agreement with <br />No. _ N-2023-111 was completed on _i 113/ and final payment has been made. <br />(List all amendments. <br />Use space below if needed.) <br />Department: <br />Phone/Ext.: A <br />Signature: Y—L� <br />Date: <br />i:lagreementslforms4orm - agreement termination fo rm —g o Id e n rod. d oc <br />