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(9) <br />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amendments (if any) are no longer in effect.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 v <br />Return form to the City Cleric's Office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with C&it V1 �h k <br />No. A-2022-230-01 was completed on _ <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />i:lagreementslfo€msVarm - agreement termination form_goldenrod.doc <br />COTC Office Use Only <br />L - 2d is <br />and final payment has been made. <br />