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City of Santa a C 2012 <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <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amendments (if any) are no longer in effect.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. N -2011 -105 (1) (11M was completed on and final payment has been made. <br />fl L (List all amendments. Use space below if needed.) <br />A 15'2011 -105 -001 (lit) Department: <br />Phone /Ext.: <br />Signature: <br />Date: <br />Revised 08 -23 -10 <br />