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City of Santa ` na <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreeffi;W. dncl all <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requireQnTs <br />have been satisfied prior to signing the termination form. C L F F ' ',- <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 />Office Use <br />No. A DLO i 1 —0 Gj 3 was completed on Z-1 O and final payment has been made. <br />(List all amendments. Use space below if needed.) /� <br />Department: � Cl A <br />Phone/Ext.: <br />Signature: <br />Date:Revised: 10-18-16 <br />