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City of Santa k . <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form 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amendments (if any) are no longer in effect.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 />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />COTC Office Use OMy <br />C''Y of "anta Ana <br />A ©2 L��3 <br />rk of the Cour.-.il <br />The agreement with DPVVtI <br />No. was completed on /SFc /6ulll and final payment has been made. <br />�\E —; 4i� p <br />(List all amendments. Use space below it needed.) <br />Department: 2Rc�SA <br />Phone/Ext.: `{^ M <br />Signature: <br />Date: <br />Revised: 01-07-16 <br />