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City of Santa Ina <br />�? <br />Clerk of the Cote. rcil <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amendments (if any) are no longer in effect.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 CLEp <br />have been satisfied prior to signing the termination form. c <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 />COTC Office Use On <br />OF T11T COUNCIL <br />.s '22 PM,4:2-9 <br />No. N-2021-207 was completed on 1'2and final payment has been made. <br />(List off amendments. Use space below N needed.) �p� <br />Department: `� �j5 l <br />Phone/Ext.: ?- <br />Signature: `— <br />Date: --6 <br />\agreements%forms6orm - agreement termination form_goldemod.doc <br />