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City of Santa / <br />Clerk of the Council coTc office use only <br />AGREEMENT TERMINATION FORM <br />Please complete this form when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />-- <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 />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 />Na N-2016-150 <br />(List all amendments. <br />Revised: 01-07-I6 <br />was completed on ZZ Z-I and final payment has been made. <br />Use space below if needed.) <br />Department: <br />�l0r—f wy <br />Phone/Ext.: <br />%( S7105 <br />Signature: <br />Date: <br />