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City of Santa t i <br />f Clerk of the Council '�— COTC Office Use <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement 9t 9511, _6 FM tL 21 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements CITY OF 5,y;t TA ANA� OF COUNCIL <br />have been satisfied prior to signing the termination form. CL t F t ` <br />Is the agreement(s) a permanent record? Yes No <br />I <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 A\r'uQncp_ err QI. Znr <br />No. N-2017-213-03 was completed on i$ and final payment has been made. <br />(List all amendments. Use space below if needed.) <br />Department: PRMA <br />Phone/Ext.: Li7-1 q <br />Signature: U7�1 fjL7/i1�i( <br />Date: <br />Revised: 10-18-16 <br />