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City of Santa P -j Clerk of the Council <br />Pk 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amendments (if any) are no longer in effect.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 />CI_F <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 /�JrlrL <br />COTC Office Use Only <br />OF T11E ulIl NC-11- <br />g "22 A410:19 <br />No. N-2022-229 was completed on 2g 22 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: W` <br />Phone/Ext.:�� — <br />Signature: <br />Date: (�� l�— <br />