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City of Santa Q„,a <br />Clerk of the Council <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amendments (if any) are no longer in effect.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 -1520 if you have any questions. <br />The agreement with <br />c,A <br />......... -------- -..................................... <br />COTC Office Use Only <br />No. N -2013 -103 was completed on j?t&3 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: F ks Ar <br />Phone /Ext.: 5D <br />Signature: �2a Ixiffi vwoa <br />Date:�y�j>� <br />Revised 10.31 -12 <br />