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City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />540 1 COTC Office Use Only <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amendments (if any) are no longer in effect.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 Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />City of Santa Ana <br />DEC 16 101i <br />Clerk of ttre Council <br />The agreement with CALtfvFNIAT(LAN',�,a-TA-t1pN cOmw..ssrrN )-4C-Aerrxaw5 <br />No. A ^Zo I C(— 2Z5- was completed on 5- 1 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />iMgmemenUforms4arm - agreement termination form_goldenrod.doc <br />Department: <br />'fw A - l' Q P--F-F= ( <br />Phone/Ext.: <br />Signature: �• �L �"`� <br />Date: <br />