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City of Santa A <br />1 Clerk of the Council corc Off ice Use Only <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amendments (if any) are no longer in effect.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— GLERK OF THE COUNCIL <br />000 2 `2 s GML e3= <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 -?V;PYY'),VQA U1,{ 4f'nA-) uQ :1 1 <br />No. N-2017-263 <br />(List all amendments. <br />Revised: 10-18-16 <br />3ola© <br />was completed on t and final payment has been made. <br />Use space below if needed.) <br />Department: -Pu ,Q,44 m,! ki ' <br />Phone/Ext.: <br />Signature:, QA1L A 1/\/a/1 <br />Date: % idudQ-) <br />