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City of Santa A"q <br />Clerk of the Count <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amendments (if any) are no longer in effect.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 />have been satisfied prior to signing the termination form. <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 />e21.7 <br />COTc office Use Only V <br />r� �`�L�, <br />e.l7 ti 23 s 9 ff <br />E� <br />Y f n <br />p <br />7R f F .... <br />Na N-2017-053 was completed on 5-11,01-7 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: &C � 4 <br />Phone/Ext.: e;�IS-Z + <br />Signature: S�S")i a _ � <br />Date: 'lot IGI 117 <br />Revised: 10-18-16 <br />