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City of Santa "na <br />p <br />�t Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement or <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amendments (if any) are no longer in effect.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 & J % IPXft r J^W <br />No. N-2022-301-01 was coed on <br />(List all amendments. <br />Use space below if needed.) <br />i7agmementsWormslform- agreement termination form_goldenrod.doo <br />O ?,Q3 <br />COTC Office Use Only <br />RK OF THE COUNCil <br />MAR 2123 PM2:23 <br />Department: UA IAo5 mitt lA -t i <br />Phone/Ext.: �JJS <br />Signature: <br />Date: O2-J(o12��3 <br />