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0City of Santa "-ia <br />Clerk of the Cou,icil <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement c <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all gran tention requirements <br />have been satisfied prior to signing the termination form. <br />Is the agreements) 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 Oniv <br />OF THE COUNCIL <br />2123 PM2:24 <br />No. A-2020-043-25 was completed on 1 /tf z- and final payment has been made. <br />(List all amendments. Use space below if needed) <br />Department: ( l,Vl f <br />Phone/Ext.: &56( <br />Signature: Cf. <br />Date: 11, 11 161 <br />iaagreements4ormsVorm - agreement termination form_goldenrod.doc <br />