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City of Santa lia <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 />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 />A-2021-107-10 <br />No. was completed on <br />(List all amendments. Use space below if needed.) <br />--yreements-formstform - agreement termination form <br />_golCpnrOd,eoc <br />COTC OfficeUseOnly <br />C 2-°233 <br />City of Santa Ans, <br />JAN 11 20A <br />meaty Clerk's Office. <br />and final payment has been made. <br />Department: <br />c- <br />Phone/Ext.: �- <br />Signature: _ <br />Date: <br />