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City of Santa A <br />t <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use <br />Please complete this form when the attached agreement and all 20-70 FEB '6 PM 3-- 37 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF' S ` N TA ANA <br />have been satisfied prior to signing the termination form. CLERK JOF COUNCIL <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 Kruk,., A xy-(� 1 c x i .S, 7Lrnc', <br />No. —�Q\y —Q\ Z —p\ was completed on 11,3i 1 j1 and final payment has been made. <br />(List all amendments. Use space below N needed.) <br />Department: PPC;S } <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 01-07-16 <br />