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City of Santa j1a <br />Clerk of the Council <br />, <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amendments (if any) are no longer in effect.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 />A-2020-043-15 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />[\agreementsUorms4orm- agreement termination form_goldenrod.doc <br />COTC Office Use Only <br />ANIA CITY CLERK <br />' 13'23 PM3:51 <br />and final payment has been made. <br />Department: /43rG, <br />Phone/Ext.:`�_� 1 <br />Signature: <br />Date: — <br />