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0�,,, City of Santa "na `l <br />Clerk of the Coy 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amendments (if any) are no longer in effect.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 CLf <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 />J bl is WOd" -P� <br />COTC Office Use Only <br />OF THE COUNCIL <br />128'23 PM4:32 <br />- vts'�rJavyfl 01 ' - vs- t <br />A 2021 068-01 I ► 0? ro`\�e �vo-c��in�-�1nt►"e n �nrc'" <br />N VI <br />No. was completed on Z7i and final paymentTiaween made. <br />(List a0 amendments. Use space below if needed) <br />ilagreements4omnaform - agreement termination form_goldenrod.doc <br />Department: CPA <br />Phone/Ext.: (�6( <br />Signature: 1/ <br />Date: U.�� <br />