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co(5 <br /> ter, City of Santa , a <br /> . r. Clerk of the Council <br /> ry <br /> AGREEMENT TERMINATION FORM 1 _COTC Office Use only <br /> i <br /> l <br /> Please complete this form when the attached agreement and all OITY Ci • <br /> amendments (if any) are no longer in effect. (- <br /> Return form to the Clerk of the Council Office (M-30). I <br /> Call 647-6520 if you have any questions. <br /> The agreement with C 3 OFf.rCc.— Sc cLL t- ,�,r f <br /> A No*4 -Z:J f j 2 `A Cb) was completed on / 3' /'S and final payment has been made. <br /> Z (List all amendments. Use space below if needed.) <br /> A-2.012 " 2 q C0 0) Department: (ems re-d Z- $ f_ti-ze-r S <br /> '414 - 1 Cu) Phone/Ext.: 1:),I.•U' .x s �"o 2 <br /> Signature: () _ / 1/ 1,6 %'/ <br /> Date: ) 2 -2 1' ' , <br /> Revised 08-23-10 <br />