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City of Santa A 7 <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />COTC Office Use <br />�?Q F <br />Please complete this form in its entirety when the attached agreement and al <br />'6 PPS [: 22 <br />amendments (if any) are no longer in effect. Cl T <br />$ <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CL F Up- r'i NH 0 t- AN.4 <br />have been satisfied prior to signing the termination form. C0(/j(C/` <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 />Na N-2017-037 was completed on YL;c n and final payment has been made. <br />(List all amendments. Use space below if needed.) (� <br />Department: PPC5A <br />Phone/Ext.: tqR <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />