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City of Santa 4 na <br />q Clerk of the Co,.rfcil <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amendments (if any) are no longer in effect.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 farm. CLER <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 i 0 D\� <br />N�"; W�-Oh0. <br />COTC Office Use Only <br />OF THE COUNCIL <br />3 28'23 PM4:32 <br />A-2020-085-01 <br />No. was completed on and final payment has been made. <br />(List all amename,,,,. __ _ pace below if needed.) <br />Department: WA- <br />Phone/Ext.: 6 5& t <br />Signature: <br />Date: I( /oli/ <br />iaagreemenislforms\farm- agreement termination form_goldenrotl.tloc <br />