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City of Santa ,na <br />... -. <br />Clerk of the Cc cil COTC Office Use Only <br />,ram <br />AGREEMENT TERMINATION FORM S)S' <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amendments (if any) are no longer in effect.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. e/// <br />tPLe=R�' OF THE CE�UNCIa <br />Is the agreement(s) a permanent record? Yes _ No J A.N 31 '23 PM3:57 <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 y2OSSTOGyI✓ ELEGTFC'4 prr"rA Wt�• <br />A _ -7— <br />zc17 r�_ ✓r <br />No. A-2c�17 _17Z- 2- was completed on and final � /22 payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: F&�A / Tn�JGFrC <br />Phone/Ext.: x <br />Signature: <br />Date: �'/"-3 2 Z <br />Revised: 10-18-)6 <br />