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_ City of Santa . la <br />=' Clerk of the Council <br />.l 1 <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amendments (if any) are no longer in effect.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. s 'o _ �� ` was completed on <br />(List all amendments. use space below if needed.) <br />Revised 08 -23 -10 <br />G201S <br />COTC Office Use Only <br />C4, YT m 1 <br />" 1 WI <br />OFr �a <br />F ✓ - .. r ti -._ <br />and final payment has been made. <br />Department: <br />Phone /Ext.: —0 <br />Signature:�e' V i� <br />Date: <br />