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City of Santa " is 1 COTC Office Use Only <br />1 Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all i <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CZFRk OF THE G-OUNCI <br />have been satisfied prior to signing the termination form. FE-B 2923 PM4:33 <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-2020-043-04 <br />No. was completed on GI�1 <br />(List all amendments. Use space below N needed.) <br />Department: <br />Phone/Ext.: <br />Signature: <br />Date: <br />i9agreementsUormslfoon - agreement termination fa m_goidenrod.doc <br />and final payment has been made. <br />