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City of Santa Ana <br />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amendments (if any) are no longer in effect.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 />Dote: 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 />The agreement with <br />COTC office Use Only <br />3 <br />3 <br />fI <br />3 <br />0 ; <br />A of Santa Ana <br />JAN 11 0 <br />3 <br />City Clerk's ice <br />No. was completed on and final payment has been made. <br />aist aft amendments, Use space below if needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />i:tagreerrentsVormsVorm - agreement termination form—goidenrod.doc <br />