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City of Santa "na <br />Clerk of the Covofcil <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amendments (if any) are no longer in effect.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 J <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office Use Only <br />I3F TGIF COUNCIL <br />28 '22 HM9:2.0 <br />The agreement with DA-ggeU Wff",e-F= dL!a 2o�-E9S1(ITnAL EN1EF-JAINM{-110-1 <br />No. N-2021-228 was completed on and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: FIC-SA <br />Phone/Ext.: Ynnf,J%p�J�- <br />Signature: c.�' <br />Date:��- <br />79agreementsHormonorm- agreement termination form—goldemod.doc <br />