For each insured whose home state is Tennessee, every new or renewed insurance contract certificate, cover note or other confirmation of insurance procured and delivered as a surplus line insurance coverage pursuant to this chapter shall bear the name and address of the writing agent and shall have stamped, affixed, or printed upon it the following: This insurance contract is with an insurer not licensed to transact insurance in this state and is issued and delivered as a surplus lines coverage pursuant to the Tennessee insurance statutes.