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City of Santa A <br />f Clerk of the CounLA <br />A. <br />A` <br />4' <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amendments (if any) are no longer in effect.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 />ON <br />ELFE RR' K 11 <br />C............... W............ <br />COTC Office Use Only <br />No. k Rol CY —,64p, was completed on and final payment has been made. <br />(List all amendments. <br />Revised: 10-18-16 <br />Use space below if needed) <br />Department: Nc -f �; <br />Phone/Ext.: ICA <br />Signature: n" <br />Date: 9 <br />