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City of Santa is <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amendments (if any) are no longer in effect.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 <br />have been satisfied prior to signing the termination form. 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 EJ L-- <br />COTC Office Use Only <br />OF THE COUNCIL <br />128123 Prt M <br />No. A-2020-043-17 was completed on q —?'r, � and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: ��- <br />Phone/Ext.: <br />Signature: <br />Date: <br />ilagreement0ormskiarm - agreement tarminafion form_goldenrod.do <br />