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city us Santa I >q <br />Clerk of the Couhcll <br />AGREEMENT TERMINATIONFORM <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amendments (if any) are no longer in effect, 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 />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 <br />No. Al -,,j /„_ 0/1,,/ was completed on <br />(list all amendments. Use space below if needed.) <br />Revised: 01-07-16 <br />CU17 <br />COTC Office Use Only <br />23 71 3• g3 <br />'ALe,5) 1 -7 and final payment has been made. <br />Department: T� <br />Phone/Ext.: 5r3zS-L+ <br />Signature: G L(A ZIRVOkexo <br />Date: 1 . �Iri <br />