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City of Santa ." .1a <br /> - Clerk of the Coy.. _il COTC Office Use Only <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 amendments (if any) are no longer in effect.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 /> Note: If your agreement is grant related, please ensure that all grant retention requirements <br /> have been satisfied prior to signing the termination form. <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 Glzes ca:v L P.4 T/?. ,it"4. <br /> No. A-20/2-/77 was completed on 0 l36//7- and final payment has been made. <br /> (List all amendments. Use space below if needed.) <br /> Department: ic'7/4`.4 !T irff iC <br /> A - / 7_02_ Phone/Ext.: yS--62 G <br /> Signature: <br /> Date: ry f 2-c'// - <br /> Revised:01-07-16 <br />