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City of Santa "na <br />r 1 Clerk of the Cour icil <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amendments (if any) are no longer in effect.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. CGI E <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 —V-r e 1 <br />M'd <br />COTC Office Use Only <br />00FrrpirrH}E COUNCLI <br />1 2i 1 L f 1omT _O <br />Na N-2021-077 was completed on_ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: T U 14 <br />Phone/Ext.: <br />Signature: �;�t�J l/�%✓Q�� <br />Date: <br />lagreemenlslformsgorm- agreement termination form goldenrod can <br />