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City of Santa .na \ �j <br />Clerk of the Council ~ <br />tri <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amendments (if any) are no longer in effect.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 CLt- <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 />No A-2021-206 was completed on <br />(List all amendments. Use space below if needed.) <br />i:\agreementomrmMfarm - agreement termination form—goldenrod.doc <br />COTC Office Use Only <br />CE Ti-iE COUjgpIL <br />and final payment has been made. <br />Department: j p—c' ' <br />Phone/Ext.: 7 <br />Signature: > <br />Date: 1 2 3 <br />Irk <br />