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City of Santa ' na � I / O� <br />Clerk of the Courrcil <br />fir! <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amendments (if any) are no longer in effect.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 <br />COTC Office Use On J <br />Return form to the Clerk of the Council Office (M-30). CLERK OF THE COUNCIL <br />Call 647-1520 if you have any questions. Al"10 922 ey= 2 -12 <br />The agreement with bad'= —Names D(A-ACQ. <br />No. N-2021-075 was completed on a 1 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.: X� <br />Signature: / <br />Date: <br />iiagreementslformslform- agreement termination form_goldenrotldoc <br />