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City of Santa Ar - <br />- Clerk of the Count <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amendments (if any) are no longer in effect.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. T, <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 Only <br />2'2 PP032 <br />N-2018-173 j <br />No. was completed on to 12011O �/ <br />and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: QRCCA 1 "Vm'o\-' <br />Phone/Ext.: ��9// M <br />Signature: <br />Date: q U�OIq <br />Revised: 10-18-16 <br />