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City of Santa I na <br />clerk of the Cou�,cil <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amendments (if any) are no longer in effect.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 />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 />�)W'1 MOU - onv-d"V-fi' <br />COTC Office Use Only <br />OF THE COUNCIL <br />. 1'21 141a:30 <br />A-2017-358-01 <br />No. was completed on 2 2� �� and final payment has been made. <br />(List all amendments. Use space below if needed.) �1n <br />Department: Vy 1n�v 'vt b �AAAY� <br />Phone/Ext.: <br />Signature: <br />Date: <br />Revised: 10-18-16 <br />