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o ,, City of Santa " na � <br />Clerk of the Cc....cil 1- <br />J-1 x� <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amendments (if any) are no longer in effect. CM <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 />A-2019-165 <br />No. <br />(List all amendments. <br />Revised: 10-18-16 <br />COTC Office Use Only <br />AMA CITY CLERK <br />13123 Pm3:44 <br />- was completed odLtV9 30j X?-Oand final payment has been made. <br />Use space below it needed.) GOP,- <br />Department: �/iJA' <br />Phone/Ext.: <br />Signature: <br />Date: <br />