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City of Santa A--j <br />Dt5✓ l.iz .... <br />Clerk of the Coun..d coTc Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all 2020 FEB -gib pM q: <br />amendments (if any) are no longer in effect. 22 <br />Note: If your agreement is grant related, please ensure that all grant retention requirementC I T Y OF W n N TA A NA <br />have been satisfied prior to signing the termination form. CLERK OF COl)NeJ(E <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 />No. N-2016-037 was completed on q lag 180jo and final payment has been made. <br />(List all amendments. Use space below if needed.) (���� <br />Department: PRCfEA <br />Phone/Ext.: Lizc\ <br />Signature: <br />Date: q IRjWill <br />Revised: 01-07-16 <br />