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0ems+ City of Santa "na <br />�� Clerk of the Cowicil 1 <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement <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amendments (if any) are no longer in effect.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 K— <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 <br />OF THE COUNCIL <br />i 27'2u PAM <br />N-2022-366 <br />No. was completed onand final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: M -;,A- <br />Phone/Ext.: <br />Signature: <br />Date: <br />ilagreementsWormsbrm - agreement termination form goldenrod coo <br />