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City of Santa ' -ia <br />Clerk of the Council COTC Office Use <br />AGREEMENT TERMINATION FORM <br />r <br />i <br />Please complete this form in its entirety when the attached agreement and 6249AU� Q AM $; <br />amendments (if any) are no longer in effect. CIT <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CLERK �A N Tq q Nq <br />have been satisfied pror to signing the termination form. O' COUNCIL <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 />A-2018-135-22A <br />No. - was completed on O-30-" t and final payment has been made. <br />(List all amendments. Use space below ff needed.) ��l Department: l 6 A <br />11, \ Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 1&18-16 <br />