Attachment J4 - Past Performance Questionnaire.docx

Attachment J4 - Past Performance Questionnaire 2/17/2026

TO: Government agency or commercial organization (i.e., customer) with knowledge of the Offeror's past performance.

Please complete this questionnaire, which concerns the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the Library of Congress (LOC). Handwritten responses are acceptable if necessary. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided LOC with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to LOC relative to their past performance, whether it is positive or negative information.

Email the completed questionnaire to the attention of the responsible Contracting Officer: Cristina Vega at cvega@loc.gov and Contract Specialist: Kevin Barnes at kbarnes@loc.gov. The Offeror must fill in the solicitation number, fax number, email address, and name of Contracting Officer below, prior to providing you with the questionnaire, or provide you with the information to fill in. Your completed questionnaire must be provided directly to the Contracting Officer from you. LOC will not accept completed questionnaires sent from the Offeror.

Offeror: Complete SECTION 1, then e-mail questionnaire to the customer points of contact listed on the Past Performance Information Sheet for the contract identified.

Offeror’s Evaluator: Complete SECTIONS 2-3 and e-mail to: cvega@loc.gov and kbarnes@loc.gov with the subject “Offeror Company Name - PAST PERFORMANCE QUESTIONNAIRE”

(DO NOT PROVIDE COPY BACK TO THE OFFEROR)

SECTION I: (To be filled out by the Offeror)

Contractor Name

Contractor UEI

Contract Name/Program Name

Contract/BPA/Task Order Number(s)

Type of Contract

Contract Period of Performance

Contract Duration

Contract/Task Order Amounts

Name/Contact Information of Customer Point of Contact for Offeror Information (Telephone, Fax, Email Address, Mail Address)

Other Relevant Information

SECTION II: (To be filled out by the client reference completing the questionnaire) The information provided in this section by the client references shall be of past performance that is relevant for contracts and/or sub-contracts in any amount and shall be on project work same or similar in nature as that provided in the performance work statement.

Name of Company/Federal, State, or Local Agency completing the Questionnaire

Name of person completing the Questionnaire

Agency/Company/Organization

Your role with respect to the Contractor (e.g. Contracting Officer, Program Manager, Consumer, etc.)

Length in role (years and months)

Email Address

Telephone Number (include area code)

Fax Number (include area code)

Other Relevant Information

Information Accuracy:

Is the information provided by the Offeror in Section I accurate, to the best of your knowledge?

[ ] YES [ ] NO

SECTION III: (To be filled out by the client reference completing the questionnaire) The information provided in this section by the client references shall be of past performance that is relevant for contracts and/or sub-contracts in any amount and shall be on project work same or similar in nature as that provided in the performance work statement.

Please use the following rating scale to rate the Contractor:

contractor was effective.

For each segment, please include narrative with specific, relevant examples where at all possible. Additional comments may be attached, as necessary.

A. Prime Contractor’s Management Practices

1. Please rate the Contractor’s Management structure in terms of responsiveness, efficiency and how well it met the needs of your company or agency.

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

2. How effective and thorough was the Contractor in reporting on the Contractor’s performance?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

3. How effective and professional was the Contractor in working and communicating with agency or customer personnel?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

B. Prime Contractor’s Performance

1. How valuable and instrumental were the Contractor’s performance reports to your agency’s goals and objectives and planning activities?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

2. How well was the Contract staffed to be able to fill requests appropriately?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

3. What was the level of skill and competency of the staff provided by the Contractor?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

4. How well did the Contractor provide Quality Control?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

5. How well did the Contractor transition into the current contract?

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

C. Prime Contractor’s Delivery Schedules

1. Please rate the Contractor’s ability to meet recurring deadlines for multiple deliverables on time.

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

2. Please rate the Contractor’s ability to meet the requirements of the Contract at the agreed upon pricing.

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

D. Summary

1. Were there any instances in which the Contractor received additional consideration for superior performance?

[ ] YES [ ] NO [ ] NOT APPLICABLE

2. Were there any instances in which the Contractor was required to provide explanations due to poor performance or the non-availability of the system/services/staff resources?

[ ] YES [ ] NO [ ] NOT APPLICABLE

Please rate the overall performance of the Contractor:

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

Not applicable

COMMENTS:

E. Additional Comments Please provide any additional comments regarding this Contractor’s past performance, as desired, either below or as an attachment:

COMMENTS:

*By signing this Questionnaire, I verify that the information contained in this reference is accurate, to the best of my knowledge.*

PRINTED NAME

TITLE

AGENCY/ORGANIZATION/ROLE

Signature

Source Selection Information – See FAR 2.101 and 3.104