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City of Santa "no <br />' Clerk of the Co%.rrcil <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and <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amendments (if any) are no longer in effect.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 />COTC Office Use ON <br />OF THE COUNCIL <br />128In P144:32 <br />g 7U t C �W �Gti,�e �ah5�t <br />The agreement with V �'� -�L(�Vl c,v� ' ���im <br />A-2021-068-02 <br />No. was completed on Ito z and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />dagreementsbrmslform - agreement termination form_goldenrod.doc <br />Department: <br />Phone/Ext.: (A (a ( <br />Signature: <br />Date: 1�2Z <br />