The 13.2kV medium-voltage underground cabling throughout the Eastern State Hospital campus where approximately 70 years old and well beyond their expected serviceable life. A cable failure could affect power distribution throughout the campus creating an emergency condition. The project replaced ~35,000 feet of medium-voltage (MV) cabling interconnecting (14) sectionalizing cabinets, (17) transformers, and (2) MV switches. The campus’s main MV switchboard was replaced and the system brought up to current code. The project’s design was phased and coordinated with the Owner to minimize operational impacts during construction. Voltage drop, fault current and arc flash study were performed with contributions from the utility company’s infrastructure. Oil samples were taken from all the oil-filled MV equipment to remain and a detailed report provided outlining the health and recommendation of the equipment for future planning. Equipment & arc flash labels were added to all equipment and vaults in correlation with the campus one-line diagram. The project structure was design-bid-build with support throughout the bidding and construction administration phases.