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City of Santa "na <br />P <br />Clerk of the Cot,rgcil <br />AGREEMENT TERMINATION FORM C tiJ <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. Cl FI <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 i lot i C wC)V 1-S <br />COTC Office Use Only <br />OF THE COUNCIL <br />R 2'23 PA:24 <br />s �'D'Pt ClN 1� <br />A-2021-068-03 <br />No. was completed on I ( 0 Z 4 and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: (,f;74 <br />Phone/Ext.: <br />Signature: <br />Date: 17i7/ <br />i.\agreements\forms\form agreement termination form _goldenroddoc <br />