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City of Santa ^ la <br />i <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amendments (if any) are no longer in effect.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. <br />Is the agreement(s) a permanent record? Yes _ No A <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 />LOS AN <br />sMSA 1.l <br />) I°AILTN ll!V S tt <br />COTC Office Use Only <br />OF THE COUNCIL <br />2 2123 PM4:25 <br />p/A VMRON <br />N Its-ULU <br />No. A- Z020 —09I33Twas completed on 9"f 20ZZ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: plyA - 06-4. EN(h. <br />Phone/Ext.: 11W) (PLI-'— 5 "43 <br />Signature: V <br />Date: del. y-.202Z <br />i'.!agreemenWforms'dorm- agreement termination form_goldenrad.doc <br />