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City of Santa I a <br />Clerk of the Council CO&6 Mice Use <br />(&-'/ r <br />AGREEMENT TERMINATION FORM i�Ct�y'A <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amendments (if any) are no longer in effect.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 />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 l"L Pv�' — 61�1 ''" <br />No. el7 — was completed on Lj / and final payment has been made. <br />r � <br />(List all amendments. Use space below N needed.) <br />C C _ Department: G'V /� — ee �t � <br />_ O Phone/Ext.: <br />Signature: rfascll Cru r,�r <br />Date: <br />Revised: 10-18-16 / <br />