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City of Santa A a <br />Clerk of the Council corc office use or y <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and <br />amendments (if any) are no longer in effect. ERK OF THE COUNCIL <br />Note: If your agreement is grant related, please ensure that all grant retention requirements JI'AN 31,23 PMj:58 <br />have been satisfied prior to signing the termination form. <br />Is the agreements) 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 l " ` / <br />A-2018-091-01 <br />No. was completed on l� �� �Z and final payment has been made. <br />(List all amendments. Use space below if needed.) ,, 77 //�� <br />Department: 6//4- <br />Phone/Ext.: (u5 (o <br />Signature: i).f- <br />Date: <br />Revised: 10-18-16 <br />