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Signature Page <br />By signing below, the local CEO and Local Board chair request approval from the Governor to be <br />an Adult and Dislocated Worker Career Services Provider. Each party certifies that this <br />application submission was reviewed and demonstrates that the Local Board or administrative <br />entity will meet all the requirements as an Adult and Dislocated Worker Career Services <br />Provider under WIOA law and regulations. <br />Instructions — The Local Board chair and local CEO must sign and date this form. Include the <br />original signatures with the request. <br />Local Workforce Development Board Chair <br />Signature <br />Lee McMu <br />Name <br />Chair, Santa Ana Workforce Development <br />Board <br />Title <br />Date <br />Page 8 of 8 <br />21A-12 <br />Local Chief Elected Official <br />Signature <br />Miguel Pulido <br />Name <br />Mayor, City of Santa Ana <br />Title <br />Date <br />