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' City of Santa A --.y <br /> �" :, �......._..............--COTC Office Use Only <br /> ` �, Clerk of the Cou��_.�I <br /> AGREEMENT TERMINATION FORM <br /> Please complete this form in its entirety when the attached agreement and VO APR 24 PM 3: 18 <br /> amendments (if any) are no longer in effect. <br /> Note: If your agreement is grant related, please ensure that all grant retention requirements C I T ' �e OF r `� i�� A N A <br /> have been satisfied prior to signing the termination form. C L i tj r COUNCIL <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 1 '1Lr„S C!�� 1 *Vx C-(.3/y'V i CILS <br /> No. - , �; (� — (t( i:' was completed on 1' i lDZ and final payment has been made. <br /> (List all amendments. Use space below if needed.) l <br /> ( j -C O i Department: A--.) I�l.�a / attb�, <br /> Phone/Ext.: �r:..S 4 <br /> Signature: =.:E C.:, t(). r_ 7\jek,/) <br /> Date: - rl <br /> Revised: 10-18-16 <br />