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City of Santa A^a <br />"-'�- Clerk of the Cour,-il <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amendments (if any) are no longer in effect.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 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 On]v <br />OF 79 HE COUNCTH' <br />1 °21 rim A u. 19 <br />No. N-2022-231 was completed on 2g 2 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: KC�y7t <br />Phone/Ext.: <br />Signature: <br />Date: <br />