Common use of INSURANCE DISCLOSURE Clause in Contracts

INSURANCE DISCLOSURE. The obligations of the provider under this Agreement are covered by a policy of insurance issued by MIC Property and Casualty Insurance Corporation, Executive/Administrative Offices: 000 Xxxxxxxx Xxxxxxxxxx, Xxxxx 000, Xxxxxxxxxx, XX 00000. In the event the provider does not pay any CLAIM or make any refund or consideration due, including the return of any unearned provider fee, within thirty (30) days after proof of loss has been filed or the provider ceases to do business or goes bankrupt, YOU may apply directly to MIC Property and Casualty Insurance Corporation for the protection afforded by this Agreement at 0-000-000-0000. State Disclosure The following is provided in accordance with RSA 415-C:6(h) of the New Hampshire Revised Statutes. In the event you do not receive satisfaction under this contract, you may contact the New Hampshire Insurance Department at the following address and telephone number: New Hampshire Insurance Department 00 Xxxxx Xxxxx Xxxxxx Concord, NH 03301 Telephone number (000) 000-0000 New Mexico Exception Language

INSURANCE DISCLOSURE. The obligations of the provider under this Agreement are covered by a policy of insurance issued by MIC Property and Casualty Insurance Corporation, Executive/Administrative Offices: 000 Xxxxxxxx Xxxxxxxxxx, Xxxxx 000, Xxxxxxxxxx, XX 00000. In the event the provider does not pay any CLAIM or make any refund or consideration due, including the return of any unearned provider fee, within thirty (30) days after proof of loss has been filed or the provider ceases to do business or goes bankrupt, YOU may apply directly to MIC Property and Casualty Insurance Corporation for the protection afforded by this Agreement at 0-000-000-0000. State Disclosure The following is provided in accordance with RSA 415-C:6(h) of the New Hampshire Revised Statutes. In the event you do not receive satisfaction under this contract, you may contact the New Hampshire Insurance Department at the following address and telephone number: New Hampshire Insurance Department 00 Xxxxx Xxxxx Xxxxxx Concord, NH 03301 Telephone number (000) 000-0000 New Mexico Exception Language0000