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City of Santa A <br />Clerk of the Council COTC Office Use Only <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreer�� tad a <br />amendments (if any) are no longer in effect. LUG rCc �PM 4' 22 <br />Note: If your agreement is grant related, please ensure that all grant retention require n{� 4 O <br />have been satisfied prior to signing the termination form. "MY I ' 5 AINTA ANA <br />CLERK 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 <br />No. N-2017-163 was completed on p and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PRC6A <br />Phone/Ext.: 41o11Q <br />Signature: <br />V <br />Date: q 120/iq <br />Revised: 10-18-16 <br />