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City of Santa "na <br />Clerk of the Council 1 I <br />V ~ AGREEMENT TERMINATION FORM �y�I <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amendments (if any) are no longer in effect.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. CI_Eli <br />I <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. N-2021-207-01 was completed on <br />(List all amendments. Use space below if needed.) <br />ilagreementslfarmMform - agreement termination form_goldenrod.doc <br />COTC Office Use Only <br />OF TPE COUNCIL <br />0 19-2 Pu4;`tca <br />us -P-Vo a-k <br />— I a- and final payment has been made. <br />Department: �S <br />Phone/Ext.: <br />Signature:�}� <br />Date:�� J��— <br />