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�., City of Santa A <br />.....- .... <br />�t t Clerk of the Council C:oTc office Use only <br />----- <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amendments (if any) are no longer in effect.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 />s the agreementf,1 ER OF agsE COUNCILs) a permanent record? Yes No AW 2 eL e Pt0:32 <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 />N-2017-263 (1 da 0 <br />No. was completed on it and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />!)—'-'�C'V1_0U3-0� Department: <br />17 Phone/Ext.: <br />Signature: i Ck , el J "I zo_ <br />Date: % /Q-IQ-1 <br />Revised: 10-18-16 <br />