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City of Santa / a <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement a <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amendments (if any) are no longer in effect.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 <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 Onlv <br />OF T 41E fM INC<+ <br />1122 PIMU (t:13 <br />No. N-2022-230 was completed on 2$ 2'z and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: <br />Phone/Ext.:�� <br />Signature: <br />Date: <br />�l <br />SSI �d 22 <br />