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City of Santa la <br />"—' Clerk of the Council <br />} AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Return form to the Clerk of the Council office (M-30). <br />Call 647-6520 if you have any questions. <br />The agreement with <br />No. D rZ3Z�31 u� was completed on <br />(List all amendments. Use space below if needed.) <br />(3I <br />COTC Office Use Only <br />n <br />` H <br />6 p I Z—O and final payment has been made. <br />Department: e 1 <br />Phone/Ext.: <br />Signature: <br />Date: 6�7Z�7S <br />V <br />Revised 0&23-10 <br />