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M City of Santa A, COTC Ofrice Use Only <br />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amendments (if any) are no longer in effect.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 grant retention requirements <br />have been satisfied prior to signing the termination farm. / <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 Cl Y -1 IlK <br />A-2022-129-01 <br />No. was completed on 62a-2 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: " CCLR� <br />Phone/Ext.: q1N- r,"Z - 5 `f43 <br />Signature: sR�- <br />u <br />Date: 1-b` a(�-�-a <br />