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City of Santa Ana COTC Office Use Only <br /> t141 Clerk of the Council <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 amendments (if any) are no longer in effect.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 X <br /> Return form to the Clerk of the Council Office (M-30). <br /> Call 647-1520 if you have any questions. <br /> The agreement with V RS GKP oN 9OLvTION5 <br /> No. A-2-° 4-2So- 01 was completed on I 0(2 1 (2-"o(1 and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: VLkNNING Pi (7,UlLDINJG1 <br /> Phone/Ext.: K 21 (1 <br /> Signature: Agfrld(LOA.. <br /> Date: 4(2q (2020 <br /> i:\agreements\forms\form-agreement termination form_goldenrod.doc <br />