This design-assist project for a new hospital tower included a Make Ready reroute of the existing chilled water, hot water, and electrical infrastructure, which served the existing active hospital to vacate the footprint of the future building. Extensive investigation was necessary to determine routing in a very congested underground setting. Substantial Investigation and design of shoring systems to support existing mission-critical hospital infrastructure during new excavation was necessary. New HHW/CHW hydronic piping will serve the new hospital building. The pipe product was pre-insulated welded steel pipe supplied by Thermacor. Installation was a phased installation to meet UCD Health’s construction program and hospital ingress/egress.