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City of Santa ` °1a � Zf) <br />'Clerk of the Cauticil ✓ <br />AGREEMENT TERMINATION FORM <br />COTC Office use Only <br />UY <br />s - -- <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />e� <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 �, ��l/n Y, <br />No4q 2010- 092 -007 (bA) was completed on ( and final payment has been made. <br />V,- (List all amendments. Use space below if needed.) <br />N-2-k)10 -py2 (b) Lori Department: <br />PhonelExt.: Al <br />Signature:' <br />r <br />Date:j <br />Revised 08 -23-10 <br />