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City Of Santa 1a <br />t Clerk of the Council yy�� <br />AGREEMENT TERMINATION FORM Sjk) JD <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amendments (if any) are no longer in effect.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-2020-251-04 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />rfegreemerts,forms+form- agreement termination form-addenrerl Jc. <br />4- 2-D <br />COTC Off Ice Use Only <br />OF THE COUNCIL <br />2'23 PH,4:26 <br />(,[ -and final payment has been made. <br />Department: ``(TA <br />Phone/Ext.: <br />Signature: <br />Date: <br />