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City of Santa A <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and2M'FEB _6 <br />PH amendments (if any) are no longer in effect. 3+ 36 <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CI j OF SA N iA AA <br />have been satisfied prior to signing the termination form. (_ E HK OF 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 r—wYN'w"(YYICrA A� 0 , <br />No. A-Oaon—Ori() was completed on 5/31 jZCj and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PRC-58 <br />Phone/Ext.: aaic� <br />Signature: <br />Date: C[ � (� %2n1cl� <br />Revised: 10-18-16 <br />