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City of Santa ..na I% COTC Office Use ON <br /><•�� Clerk of the Council CLERK F THE COUNCIL <br />AGREEMENT TERMINATION FORM JAM, 31'23PM2:47 <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amendments (if any) are no longer in effect.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 —L <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 />ks <br />No. N-2022-323 was completed on <br />(List all amendments. Use space below if needed.) <br />i.lagreementsUormslform- agreement termination form—goldenrod.doc <br />\0 i <br />jo % Z�> and final payment has been made. <br />Department: 5A- <br />Phone/Ext.: ��IZ <br />Signature: <br />Date: <br />