Private Provider Registration

Representative Name	License Number	License Type	License Trade	License Status	Provider Type	Firm Name	Firm Address	Firm Status	Professional Liability Coverage

DEXTER BLEASDELL	PE12345	Professional Engineer	MECHANICAL	Pending	Private Provider	BEYOND	126 NE 120TH ST	Inactive	$1 MILLION PER OCCURRENCE $2 MILLION IN THE AGGREGATE
DEXTER BLEASDELL	PE12345	Professional Engineer	BUILDING	Pending	Duly Authorized and Private Provider	MIAMI DADE COUNTY	1155 NE 126TH ST	Inactive	$2 MILLION PER OCCURRENCE $4 MILLION IN THE AGGREGATE