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City of Santa ' -ia <br />r <br />Clerk of the Council <br />COTC Office Use Onlv <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreemen 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amendments (if any) are no longer in effect.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 />No. A-2020-043-28 was completed on <br />(List all amendments. Use space below if needed.) <br />hagreements\forms\form - agmement termination form_goldenrod.doc <br />OF THE COUNCIL <br />R 2123 PM2:24 <br />fu ( and final payment has been made <br />Department: <br />0/ i <br />Phone/Ext.: <br />�5(01 <br />Signature: <br />Date: <br />SI I I I%% <br />