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City of Santa p- -i <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />Please complete this form when the attached agreement and allf =' 1 4` pg f,• rn <br />amendments (if any) are no longer in effect, <br />-u <br />Return form to the Clerk of the Council Office (M -30). <br />Call 647 -6520 if you have any questions. <br />�v <br />The agreement with " j& ,jY0' &4y-( CjCA Yw/ tw <br />No. t J- 11- OCI (e7 was completed on 1 1 � and final payment has been made, <br />(List all amendments. Use space below if needed.) <br />Department: P t A- <br />Phone /Fxt.:� <br />Signature: j A,)' <br />Date: (pjIq- <br />Revised 08 -2310 <br />