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City of Santa "na <br />Clerk of the Co ocil <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amendments (if any) are no longer in effect.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 <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 />C6 T f COUNCIL <br />_ 26122 Pm4:2 :' <br />A-2017-125-01 <br />No. was completed on ?✓( and final payment has been made. <br />(List all amendments. use space below if needed.) <br />A-2-ol (� - (ay Department: <br />k - [11'K9' Phone/Ext.: <br />A ��a�' b-l� Signature: <br />v <br />Date: <br />i:lagr@ementr;Varmslform - agreement termination form_goldenrod.doc <br />