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City of Santa A <br />Clerk of the Council cotcoffice 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amendments (if any) are no longer in effect.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 />CM RK OF HE COUNCIL <br />Is the agreement(s) a permanent record? Yes NoAUG 2 + = F v32 <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 -?Q�W',Q-9 V Q,4� l p _ :1 'L + <br />N-2017-263 U 1' � d`fi <br />No. was completed on and final payment has been made. <br />(List aft amendments. Use space below if needed.) <br />1j-aoI7—�(�3 <br />Revised: 10-18-16 <br />Department: P9L&4} ) Od Yi' ! k,- <br />Phone/Ext.: si <br />Signature: /V��u�l�l <br />Date: % / -YI ;;Z-1 <br />