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City of Santa la COTC Office Use Only <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amendments (if any) are no longer in effect.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 agreementSANTO, ANA CITY CLERKs) a permanent record? Yes Nov :SAP 13'23 PM3:4f3 <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 ON <br />A-2020-043 <br />No. -161A was completed onC4 c? and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.:�/� <br />Signature: <br />Date: <br />15� —t " 9 J <br />0agreemen1sgormslform agreement termination form_goldenroddoc <br />