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City of Santa a <br />Clerk of the Council COTIC Office use Only <br />--- --------- <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety 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amendments (if any) are no longer in effect.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 />CLERK OF THE COUNCIL <br />have been satisfied prior to signing the termination form, <br />AUG 2'21- PmM.11 <br />Is the agreement(s) a permanent record? Yes — No <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-2017-005 was completed on G and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: FRC'sa <br />Phone/Exf.: IJU 114 <br />Signature: <br />Date: U/go IR <br />Revised: 10- 18-16 <br />