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City of Santa Ana <br />City Clerk hog <br />AGREEMENT TERMINATION FORM <br />ww' <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amendments (if any) are no longer in effect.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 />Itel <br />No. N-2023-059 was completed on <br />(List all amendments. Use space below if needed.) <br />I'. lagreements4ormsUorm - agreement lerminafion form—goldenmd.doc <br />COTC Office Use Only <br />City of Santa Ana <br />JUL. 06 2023 <br />City Clerk's Office <br />�3 and final payment has been made. <br />Department: 'y1� <br />Phone/Ext.: y141'1 <br />Signature: _&em <br />Date: : CQa, ( ? 3 <br />