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City of Santa P -,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amendments (if any) are no longer in effect.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 647-6520 if you have any questions. <br />The agreement with <br />G201S <br />COTC Office Use Only <br />EA <br />16 3- 27 AN 6'. 17 <br />No. N-2015-069 was completed on CflyLiA m- and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: F11:N1 <br />Phone/Ext.: <br />Signature: CA C1)1 I <br />Date: —A � k0 <br />Revised 08-23-10 <br />