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City of Santa I :j 20V <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use Only <br />at <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amendments (if any) are no longer in effect.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). h <br />Call 647 -6520 if you have any questions. <br />The agreement with <br />No. N- 2012 -077 was completed on <br />(List all amendments. Use space below if needed.) <br />Revised 08 -23 -10 <br />and final payment has been made. <br />Department: POIS A- <br />Phone /Ext.:, <br />Signature: I ,'{3, c <br />Date: <br />