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City of Santa Ana <br />City Clerk <br />AGREEMENT TERMfNATfON FORM <br />RA <br />Ci Clerk's Office Use On! <br />G - ZoZ3 <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amendments (if any) are no longer in effect.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-2023-270 <br />Ica m <br />No. " <br />was <br />eted on <br />(Lis' all amendments. Use spa a below if Ineeded.) ) and final payment has been made. <br />raagreementslformslform - agreement lerminalion form`goldenrod.doc <br />Department: R <br />Phone/Ext.: <br />Signature: <br />Date: <br />