Request for Modular System Furniture Review
Date:
RESD Project #:
PIA No:
Please review this request for Modular System Furniture to determine if CALPIA will accept or refer this project.
Agency Name:
Project Name:
Project Address:
Estimated Occupancy Date: Estimated Dollar Amount:
Number of Workstations: Number of Rooms:
Future potential projects that will mix and intermember:
Percent of facility already MSF: Which System:
Estimated Installation Date: Will installation be in phases? 
If yes, how many? and what size?  
Is there a potential double rent situation?
Agency Contact: Phone Number:
E-mail: Fax Number:
Comments:
Planner: Phone Number:
E-mail: Fax Number:
Label If CALPIA accepts or refers this project you do not need a Prison Industry Authority examption. If CALPIA accepts the project and you want another vendor, you must submit a CALPIA exemption request found at CALPIA's website - www.calpia.ca.gov. For further information contact CALPIA.