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City of Santa ' is <br />f 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amendments (if any) are no longer in effect.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 grantt I ration requirements <br />have been satisfied prior to signing the termination form. / CI_ER <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 Only II'i <br />OF THE COUNCIL <br />IR 2123 Pm2:241 <br />l/ <br />No. A-2020-043-27 was completed on K (2Z and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: (I0i1� <br />Phone/Ext.: <br />Signature: <br />Date: ZZ <br />0agreemenlslformslform - agreement ermination form_goidenrod.doc <br />