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City of Santa .na <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amendments (if any) are no longer in effect.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 />Note: If your agreement is grant related, please ensure that all grant retention requirements CLE <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 />No. A-2021-206 was completed on <br />(List all amendments. Use space below if needed.) <br />h2C) C)C-3 <br />A-20ia -Zoo <br />i:tagreements4orms4orm agreement termination form_goldenrod.doc <br />f1 <br />COTC Office Use Only <br />OF THE COUNCIL <br />128'23 PM4:33 <br />and final payment has been made. <br />Department: <br />Phone/Ext.: �J (pC✓%— <br />Signature: <br />Date: ) <br />Inc <br />