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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 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amendments (if any) are no longer in effect.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 />CLERK [IF THE COUNCIL <br />Is the agreement(s) a permanent record? Yes No WO 219-t P I�,.3:31 <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 C (% Q G 1 1. 1i1 <br />No. N-2017-183 was completed on IQi;1 I1-1 and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: J,,� �t <br />��.�,! <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />